Provider Demographics
NPI:1497744635
Name:AHLUWALIA, PRABHAT (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAT
Middle Name:
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1023
Mailing Address - Country:US
Mailing Address - Phone:315-525-3588
Mailing Address - Fax:315-823-1295
Practice Address - Street 1:140 BURWELL ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1725
Practice Address - Country:US
Practice Address - Phone:315-823-1111
Practice Address - Fax:315-823-1295
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2016-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154104-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00774910Medicaid
NY50928BMedicare UPIN