Provider Demographics
NPI:1790276780
Name:RAVAL, NILESH KAUSHIK (MD)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:KAUSHIK
Last Name:RAVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MOTOR PKWY STE A2
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5112
Mailing Address - Country:US
Mailing Address - Phone:631-234-5666
Mailing Address - Fax:631-234-0539
Practice Address - Street 1:700 WHITE PLAINS RD STE 309
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5032
Practice Address - Country:US
Practice Address - Phone:631-234-5666
Practice Address - Fax:631-234-0539
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-08-05
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Provider Licenses
StateLicense IDTaxonomies
MI4351034422207W00000X
NY314593207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology