Provider Demographics
NPI:1437269909
Name:PRAKASH, ANANTH N (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ANANTH
Middle Name:N
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HAMBURG TURNPIKE
Mailing Address - Street 2:UNIT 207
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-653-3366
Mailing Address - Fax:973-653-3365
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:UNIT 207
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2150
Practice Address - Country:US
Practice Address - Phone:973-653-3366
Practice Address - Fax:973-653-3365
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30324207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12037OtherAMERIGROUP
NJ5710247OtherGHI
NJP1831232OtherOXFORD
NJ221963249OtherQUALCARE
NJ3583406Medicaid
NJ1530046OtherCIGNA
NJ0K2307OtherHEALTHNET
NJ0072037000OtherAMERIHEALTH
NJ550478OtherUNITED HEALTHCARE
NJBE000008400OtherAMERICHOICE
NJ1042675OtherHORIZON NJ HEALTH
NJ4094510OtherAETNA
NJCC8414OtherRAILROAD MEDICARE
NJ005094Medicare PIN
NJP1831232OtherOXFORD