Provider Demographics
NPI:1861654352
Name:KINGS HIGHWAY MEDICAL PC
Entity Type:Organization
Organization Name:KINGS HIGHWAY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-787-1900
Mailing Address - Street 1:2519 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5230
Mailing Address - Country:US
Mailing Address - Phone:718-787-1900
Mailing Address - Fax:718-382-5252
Practice Address - Street 1:2519 AVENUE O
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5230
Practice Address - Country:US
Practice Address - Phone:718-787-1900
Practice Address - Fax:718-382-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1925692279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02236428Medicaid
NYG02944Medicare UPIN
NY02236428Medicaid
NYA400010915Medicare PIN
NYA100001286Medicare PIN