NPIMap

Organization Active NPI

Gangaram Ragi

Doing business as Advanced Laser & Skin Cancer Ctr LLC

  • Dermatology Physician
  • Teaneck, NJ
National Provider Identifier
1124138995
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GANGARAM RAGI
Doing business as
Advanced Laser & Skin Cancer Ctr LLC
Practice address
870 Palisade Avenue
Suite 302
Teaneck, NJ 07666-3446
Phone
(201) 836-9696
NPI assigned
Aug 30, 2006
Last updated
Apr 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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

Authorized official

Name
Gangaram Ragi, MDNPI 1801906680
Title
Member
Phone
(201) 836-9696

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X NJ Primary

Addresses

Primary practice location

870 Palisade Avenue
Suite 302
Teaneck, NJ 07666-3446

Mailing address

870 Palisade Avenue
Suite 302
Teaneck, NJ 07666-3446
Phone (201) 836-9696

Other names 1

  • Advanced Laser & Skin Cancer Ctr LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120224000099 NJ Part B Supplier - Clinic/Group Practice 6901064757 Receives reassigned benefits from 14 practitioners
Practice locations: Saddle River, NJ; Teaneck, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0682950Advanced Laser and Skin Cancer Center, LLC870 Palisade Avenue, Suite 302, Teaneck, NJ 07666ComplianceJan 12, 2027

National Provider Directory

National Provider Directory

Locations

82 E Allendale Rd
Ste 8
Saddle River, NJ 07458

870 Palisade Ave
Ste 302
Teaneck, NJ 07666
Phone (201) 836-9696

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1124138995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 PALISADE AVENUE",
            "address_2": "SUITE 302",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663446",
            "telephone_number": "201-836-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 PALISADE AVENUE",
            "address_2": "SUITE 302",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663446",
            "telephone_number": "201-836-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GANGARAM RAGI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "RAGI",
        "authorized_official_first_name": "GANGARAM",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "201-836-9696",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Laser & Skin Cancer Ctr LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Teaneck, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.