Provider Demographics
NPI:1659452407
Name:KALE, PRABHAKAR BALKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAKAR
Middle Name:BALKRISHNA
Last Name:KALE
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 1:4 PEMBURY CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3303
Mailing Address - Country:US
Mailing Address - Phone:631-643-8376
Mailing Address - Fax:
Practice Address - Street 1:4 PEMBURY CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3303
Practice Address - Country:US
Practice Address - Phone:631-643-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1221352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF37190Medicare UPIN