Provider Demographics
NPI:1902853153
Name:PANDURANG M. PRABHU M.D., P.C
Entity Type:Organization
Organization Name:PANDURANG M. PRABHU M.D., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANDURANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRABHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-2040
Mailing Address - Street 1:3131 NYS ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6755
Mailing Address - Country:US
Mailing Address - Phone:845-561-2040
Mailing Address - Fax:
Practice Address - Street 1:3131 NYS ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6755
Practice Address - Country:US
Practice Address - Phone:845-561-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145840261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care