Provider Demographics
NPI:1114432226
Name:PUNAM PRABHAKAR MD PC
Entity Type:Organization
Organization Name:PUNAM PRABHAKAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PUNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABHAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-224-4496
Mailing Address - Street 1:2200 NORTHERN BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1221
Mailing Address - Country:US
Mailing Address - Phone:516-415-0514
Mailing Address - Fax:516-277-2277
Practice Address - Street 1:2200 NORTHERN BLVD STE 128
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1221
Practice Address - Country:US
Practice Address - Phone:917-224-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty