Provider Demographics
NPI:1164408134
Name:SINGH, PRITAM (MD)
Entity Type:Individual
Prefix:
First Name:PRITAM
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2704
Mailing Address - Country:US
Mailing Address - Phone:718-278-1484
Mailing Address - Fax:718-777-0109
Practice Address - Street 1:2714 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2704
Practice Address - Country:US
Practice Address - Phone:718-278-1484
Practice Address - Fax:718-777-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0034469OtherGHI COMMERCIAL
NY040426017698OtherFIDELIS
NY119394-AOtherHEALTH FIRST
NY6C3011OtherHEALTHNET
NY82459OtherUNITED HEALTHCARE
NYP767965OtherOXFORD HEATH PLAN
NY0H942POtherHIP OF NY
NY5651121OtherAETNA
NY00223794Medicaid
NY0H942POtherHEALTHCARE PARTNERS
NY9054865OtherCIGNA
NY100008245901OtherAMERICHOICE
NY182380OtherELDERPLAN
NY1000015523OtherAFFINITY
NY119394OtherLIC #
NYP767965OtherOXFORD HEATH PLAN
NY00223794Medicaid