Provider Demographics
NPI:1902856834
Name:TRIVEDI, PRABHAS (MD)
Entity Type:Individual
Prefix:MR
First Name:PRABHAS
Middle Name:
Last Name:TRIVEDI
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:PO BOX 4979
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-4979
Mailing Address - Country:US
Mailing Address - Phone:732-244-4700
Mailing Address - Fax:732-244-2804
Practice Address - Street 1:26 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4743
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:848-251-2189
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07651700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076559OtherMEDICARE PTAN
NJ1101489OtherAMERIGROUP
NJP5490287OtherOXFORD
NJ0310573Medicaid
NJ076559C2HMedicare PIN