Provider Demographics
NPI:1508992017
Name:SALICKRAM, RAVI R (RPA)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:R
Last Name:SALICKRAM
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 TOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1745
Mailing Address - Country:US
Mailing Address - Phone:347-855-7284
Mailing Address - Fax:631-883-8496
Practice Address - Street 1:554 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1745
Practice Address - Country:US
Practice Address - Phone:347-855-7284
Practice Address - Fax:631-883-8496
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP54318363AM0700X
NY012971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical