Provider Demographics
NPI:1831421304
Name:RAMANATHAN, PREMA (DC)
Entity type:Individual
Prefix:DR
First Name:PREMA
Middle Name:
Last Name:RAMANATHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1545
Mailing Address - Country:US
Mailing Address - Phone:607-239-4310
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1545
Practice Address - Country:US
Practice Address - Phone:607-239-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011999-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor