Provider Demographics
NPI:1508186651
Name:REDDY, PRABHAKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHAKAR
Middle Name:
Last Name:REDDY
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 1:133-38 126TH STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420
Mailing Address - Country:US
Mailing Address - Phone:718-843-0333
Mailing Address - Fax:
Practice Address - Street 1:1200 EAST PUTNAM AVE
Practice Address - Street 2:GREEWICH WALK IN MEDICAL CTR
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878
Practice Address - Country:US
Practice Address - Phone:203-698-4006
Practice Address - Fax:203-698-2291
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine