Provider Demographics
NPI:1083916571
Name:PREHEALTHCARE MANAGEMENT ASSOCIATES INC.
Entity Type:Organization
Organization Name:PREHEALTHCARE MANAGEMENT ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLIKARJUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-487-5858
Mailing Address - Street 1:307 E SHORE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2420
Mailing Address - Country:US
Mailing Address - Phone:516-487-5858
Mailing Address - Fax:516-487-3133
Practice Address - Street 1:307 E SHORE RD FL 2
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2420
Practice Address - Country:US
Practice Address - Phone:516-487-5858
Practice Address - Fax:516-487-3133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREHEALTHCARE MANAGEMENT ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty