Provider Demographics
NPI:1013107184
Name:PRASAD, MANOOJ (DPM)
Entity Type:Individual
Prefix:DR
First Name:MANOOJ
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 RIVER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5227
Mailing Address - Country:US
Mailing Address - Phone:732-987-9950
Mailing Address - Fax:
Practice Address - Street 1:637 RIVER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5227
Practice Address - Country:US
Practice Address - Phone:732-987-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00292900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery