Provider Demographics
NPI:1770501603
Name:SACHAN-PRASAD, SURABHI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SURABHI
Middle Name:
Last Name:SACHAN-PRASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1565
Mailing Address - Country:US
Mailing Address - Phone:732-382-1699
Mailing Address - Fax:
Practice Address - Street 1:181 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1565
Practice Address - Country:US
Practice Address - Phone:732-382-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062457207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7138806Medicaid
NJG40808Medicare UPIN
NJ7138806Medicaid