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Organization

INTERCOUNTY OBGYN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BALA KB RAVI SR. MD (OWNER PHYSICIAN)
(718) 497-3121
Entity
Organization

Contact information

Practice address
6608 FRESH POND ROAD, RIDGEWOOD, NY 11385
(718) 497-3045
(718) 497-3126
Mailing address
PO BOX 370508, BROOKLYN, NY 11237
(718) 497-3121
(718) 497-3126

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
203725
NY

Other

Enumeration date
11/13/2006
Last updated
08/22/2020
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