Provider Demographics
NPI:1023551439
Name:PRABHAKARAN, ANUJAN (PT)
Entity Type:Individual
Prefix:
First Name:ANUJAN
Middle Name:
Last Name:PRABHAKARAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 93RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7391
Mailing Address - Country:US
Mailing Address - Phone:212-580-0125
Mailing Address - Fax:
Practice Address - Street 1:250 W 93RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7391
Practice Address - Country:US
Practice Address - Phone:212-580-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist