Provider Demographics
NPI:1942259205
Name:PRASAD, ANKINEEDU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKINEEDU
Middle Name:
Last Name:PRASAD
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 1:12 NORTHUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2615
Mailing Address - Country:US
Mailing Address - Phone:516-450-0701
Mailing Address - Fax:516-822-3067
Practice Address - Street 1:894 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3618
Practice Address - Country:US
Practice Address - Phone:516-450-0701
Practice Address - Fax:516-822-3067
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199086207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine