Jose Agustin Ravelo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DI20448 Issued in NJ

Practice address

5620 Bergenline Ave Ste 2
West New York, NJ 07093-1257

Phone

(201) 861-9400

Fax

(201) 861-9199

NPI assigned

May 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1487601613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 BERGENLINE AVE STE 2",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070931257",
            "telephone_number": "201-861-9400",
            "fax_number": "201-861-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 BERGENLINE AVE STE 2",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070931257",
            "telephone_number": "201-861-9400",
            "fax_number": "201-861-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVELO",
        "first_name": "JOSE",
        "middle_name": "AGUSTIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "046379-1",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI20448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8453501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raffaele Gibilisco,MD,PA
• Jayashree Ramakrishnan, D.D.S.
• Luz Selenia Ramos, APRN-C
• Rey Fernando Pedraza Ramos, M.D.
• Gavriel Raskin, DMD
• Shweta Rawal
• John D Rector Jr., DPT
• Reemberto J Maquieira
• Regain Physical Therapy, LLC
• RGM Multiple Diagnostic Center, LLC

• General Practice Dentistry in West New York, NJ
• Providers in West New York, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; 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.