Provider Demographics
NPI:1689782443
Name:PISHAROTY, ANIL PRABHAKARAN (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:PRABHAKARAN
Last Name:PISHAROTY
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:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-0079
Mailing Address - Country:US
Mailing Address - Phone:201-339-1700
Mailing Address - Fax:201-339-6972
Practice Address - Street 1:92-29 QUEENS BLVD 1A
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:201-339-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204088207LP2900X
NY2040881207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08047GOtherGROUP
NY06053AMedicare ID - Type Unspecified
G33910Medicare UPIN