Provider Demographics
NPI:1780713255
Name:TIKOO, RAVINDER (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:
Last Name:TIKOO
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 1:9225 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5361
Mailing Address - Country:US
Mailing Address - Phone:201-869-2707
Mailing Address - Fax:
Practice Address - Street 1:9225 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5361
Practice Address - Country:US
Practice Address - Phone:201-869-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1982522084N0400X
NJ25MA084336002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01614171Medicaid
NYG13370Medicare UPIN
NJ501261Medicare PIN