NPIMap

Organization Active NPI

Ravi C Maddali, DDS, PC

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1114178795
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
045922-1 Issued in NY
Legal business name
RAVI C MADDALI, DDS, PC
Practice address
639 W 173Rd St Apt 1a
New York, NY 10032-1426
Phone
(212) 928-4480
Fax
(212) 928-8389
NPI assigned
Oct 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ravi C Maddali, DDSNPI 1528014602
Title
President
Phone
(212) 928-4480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 045922-1 NY Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 051162-1 NY
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 034679-1 NY

Addresses

Primary practice location

639 W 173Rd St Apt 1a
New York, NY 10032-1426

Mailing address

639 W 173Rd St Apt 1a
New York, NY 10032-1426
Phone (212) 928-4480

Other identifiers 3

IdentifierTypeStateIssuer
00445625MedicaidNY
02559039MedicaidNY
01704829MedicaidNY

National Provider Directory

National Provider Directory

Locations

639 W 173rd St
Apt 1A
New York, NY 10032
Phone (212) 928-4480

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1114178795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 W 173RD ST APT 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321426",
            "telephone_number": "212-928-4480",
            "fax_number": "212-928-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 W 173RD ST APT 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321426",
            "telephone_number": "212-928-4480",
            "fax_number": "212-928-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVI C MADDALI, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-01",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "MADDALI",
        "authorized_official_first_name": "RAVI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-928-4480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045922-1",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051162-1",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "034679-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00445625",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02559039",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01704829",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.