Raveendranath, Brooke A
Raveendranath, Brooke A is an individual health care provider with primary practice located at 6 Executive Park Dr , Albany NY 12203-3791. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Raveendranath, Brooke A can be contacted via phone (518) 641-6319.Contact Information
Primary practice address
6 Executive Park Dr
Albany NY 12203-3791
Phone: (518) 641-6319
Fax: (518) 641-6850
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 381788 | New York |
Profile Details
| NPI number | 1891849618 |
|---|---|
| LBN Legal business name | Raveendranath, Brooke A |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 22nd, 2007 |
| Last updated | Jun 9th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891849618 | NPPES |
| New York | MEDICAID | 02848268 | |
| New York | Other | 000420465001 | |
| New York | Other | 3010992 | |
| New York | Other | 143259 | |
| New York | Other | 091210000047 |
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