Provider Demographics
NPI:1831457019
Name:MEERA PRABHAT PHYSICIAN P.C.
Entity Type:Organization
Organization Name:MEERA PRABHAT PHYSICIAN P.C.
Other - Org Name:MEERA PRABHAT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-445-8994
Mailing Address - Street 1:14416 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2244
Mailing Address - Country:US
Mailing Address - Phone:718-445-8994
Mailing Address - Fax:718-445-9035
Practice Address - Street 1:14416 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2244
Practice Address - Country:US
Practice Address - Phone:718-445-8994
Practice Address - Fax:718-445-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115635261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17014Medicare UPIN
NY10778Medicare PIN