Provider Demographics
NPI:1184797987
Name:CHALASANI, PRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:CHALASANI
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 1:1400 AVENUE OF THE AMERICAS
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2501
Mailing Address - Country:US
Mailing Address - Phone:877-870-4590
Mailing Address - Fax:718-237-8938
Practice Address - Street 1:1400 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 1103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2501
Practice Address - Country:US
Practice Address - Phone:877-870-4590
Practice Address - Fax:718-237-8938
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111694208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00201583Medicaid
NY64418100Medicare ID - Type Unspecified