Provider Demographics
NPI:1801942644
Name:RAMAMOORTHY, RAVISHANKAR (MD)
Entity type:Individual
Prefix:DR
First Name:RAVISHANKAR
Middle Name:
Last Name:RAMAMOORTHY
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 1:1130 MCBRIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3806
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:973-812-1404
Practice Address - Street 1:1825 ROUTE 23
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7526
Practice Address - Country:US
Practice Address - Phone:973-633-1484
Practice Address - Fax:973-633-7980
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06462700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0458911Medicaid
NJH30202Medicare UPIN