Provider Demographics
NPI:1164417523
Name:PRASAD, SANJIV (MD)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:PRACTICE ASSOCIATES MEDICAL GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:211 MOUNTAIN AVE
Practice Address - Street 2:ASSOCIATES IN CARDIOVASCULAR DISEASE LLC
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2221
Practice Address - Country:US
Practice Address - Phone:973-467-0005
Practice Address - Fax:973-912-8989
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07221700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0270911Medicaid
G90494Medicare UPIN
NJ067749U77Medicare PIN
NJ067749QKFMedicare ID - Type Unspecified