Provider Demographics
NPI:1124138995
Name:GANGARAM RAGI
Entity type:Organization
Organization Name:GANGARAM RAGI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GANGARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-836-9696
Mailing Address - Street 1:870 PALISADE AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3446
Mailing Address - Country:US
Mailing Address - Phone:201-836-9696
Mailing Address - Fax:
Practice Address - Street 1:870 PALISADE AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3446
Practice Address - Country:US
Practice Address - Phone:201-836-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ234773Medicare PIN