Provider Demographics
NPI:1154578136
Name:RATINOV, EDITH MARIE (PA-C MPAS)
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:MARIE
Last Name:RATINOV
Suffix:
Gender:F
Credentials:PA-C MPAS
Other - Prefix:MISS
Other - First Name:EDITH
Other - Middle Name:MARIE
Other - Last Name:SELOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C MPAS
Mailing Address - Street 1:125 CABRINI BLVD
Mailing Address - Street 2:APT A 21
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3439
Mailing Address - Country:US
Mailing Address - Phone:347-703-0917
Mailing Address - Fax:
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:6 HUDSON NORTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-9042
Practice Address - Fax:212-305-2168
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012697363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical