Provider Demographics
NPI:1184787103
Name:PRATIK INC
Entity type:Organization
Organization Name:PRATIK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PINAKIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-366-1223
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:SUITE 2R
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2043
Mailing Address - Country:US
Mailing Address - Phone:973-366-1223
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 2R
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:973-366-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA-64185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ892824ZBZLMedicare PIN
G24852Medicare UPIN
NJ892824Medicare ID - Type Unspecified
NJ139144Medicare PIN