Provider Demographics
NPI:1427244276
Name:BHACHAWAT, RAVINDRA KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:KUMAR
Last Name:BHACHAWAT
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:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-0852
Mailing Address - Country:US
Mailing Address - Phone:631-465-9333
Mailing Address - Fax:
Practice Address - Street 1:7 WOODBURY FARMS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1242
Practice Address - Country:US
Practice Address - Phone:631-465-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2463002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03120867Medicaid