Provider Demographics
NPI:1972591014
Name:CHORDIA, PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:CHORDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BROADWAY STE 303
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2747
Mailing Address - Country:US
Mailing Address - Phone:516-368-2427
Mailing Address - Fax:631-789-8571
Practice Address - Street 1:221 BROADWAY STE 303
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2747
Practice Address - Country:US
Practice Address - Phone:516-368-2427
Practice Address - Fax:631-789-8571
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47M7012084A0401X
NY134915-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01222935Medicaid
NY01222935Medicaid
NYG36022Medicare UPIN