Provider Demographics
NPI:1700140704
Name:REDDI, RAVI KIRAN
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:KIRAN
Last Name:REDDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W 120TH ST
Mailing Address - Street 2:APT 1H1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6710
Mailing Address - Country:US
Mailing Address - Phone:785-313-2981
Mailing Address - Fax:
Practice Address - Street 1:2250 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9402
Practice Address - Country:US
Practice Address - Phone:718-798-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program