Provider Demographics
NPI:1417983461
Name:DAS, PRABHAT R (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAT
Middle Name:R
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1398 CABERNET CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2760
Mailing Address - Country:US
Mailing Address - Phone:732-370-6653
Mailing Address - Fax:732-736-6954
Practice Address - Street 1:1166 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5600
Practice Address - Country:US
Practice Address - Phone:732-370-6653
Practice Address - Fax:732-736-6954
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06729400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ15824Medicare ID - Type Unspecified
NJF63031Medicare UPIN