Provider Demographics
NPI:1396205639
Name:POPHALI, PRATEEK AVINASH (MD)
Entity Type:Individual
Prefix:
First Name:PRATEEK
Middle Name:AVINASH
Last Name:POPHALI
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:JACOBI MEDICAL CENTER
Mailing Address - Street 2:1400 PELHAM PARKWAY SOUTH, BRONX
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JACOBI MEDICAL CENTER
Practice Address - Street 2:1400 PELHAM PARKWAY SOUTH, BRONX
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program