Provider Demographics
NPI:1871662361
Name:MANOHARAN, PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:MANOHARAN
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 1:1 REGIMENTAL PL
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5621
Mailing Address - Country:US
Mailing Address - Phone:718-541-2168
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:ST LUKES CORNWALL HOSPITAL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:845-790-2675
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002681-1207L00000X
FLME133099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02824679Medicaid
NYA400083730Medicare PIN
NYG400086188Medicare PIN