Provider Demographics
NPI:1700800083
Name:RAVI, NANJAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANJAPPA
Middle Name:
Last Name:RAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-1097
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-967-8443
Practice Address - Street 1:260 OLD HOOK RD.
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3123
Practice Address - Country:US
Practice Address - Phone:201-666-7200
Practice Address - Fax:201-666-5612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03805000207R00000X
NJ25MA03805000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0324205Medicaid
NJ440973Medicare ID - Type Unspecified