Provider Demographics
NPI:1134639461
Name:OUR DOCTOR IN THE HOUSE LLC
Entity type:Organization
Organization Name:OUR DOCTOR IN THE HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PREMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-979-1536
Mailing Address - Street 1:14 BRYCE WAY
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2545
Mailing Address - Country:US
Mailing Address - Phone:973-891-1321
Mailing Address - Fax:973-206-5049
Practice Address - Street 1:400 ROUTE 10 W STE 1AND2
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2104
Practice Address - Country:US
Practice Address - Phone:973-891-1321
Practice Address - Fax:973-206-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty