Provider Demographics
NPI:1316951908
Name:KURUVILLA, RANJITH THOMAS (MPT)
Entity type:Individual
Prefix:MR
First Name:RANJITH
Middle Name:THOMAS
Last Name:KURUVILLA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:RENJITH
Other - Middle Name:THOMAS
Other - Last Name:KURUVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 EARLE OVINGTON BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3610
Mailing Address - Country:US
Mailing Address - Phone:516-321-2400
Mailing Address - Fax:516-321-2424
Practice Address - Street 1:99 DUTCH HILL RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2185
Practice Address - Country:US
Practice Address - Phone:845-398-2800
Practice Address - Fax:845-398-2818
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027352-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ37C5QA561Medicare PIN
NYQ4WFH1Medicare PIN
NYQ37C5QD252Medicare PIN