Individual
MR. STEPHEN BRADLEY RAVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
63 MAIN STREET, KINGS PARK, NY 11754
(631) 269-4600
(631) 269-0801
Mailing address
63 MAIN STREET, KINGS PARK, NY 11754
(631) 269-4600
(631) 269-0801
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N004798
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01271269
—
NY
01
—
19966
VYTRA
—
01
—
4C1647
HEALTHNET
—
01
—
6299184
GHI
—
01
—
C5267
OXFORD
—
01
—
P55031
BLUE CROSS
—
Enumeration date
11/01/2006
Last updated
03/05/2008
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