Provider Demographics
NPI:1295803633
Name:PRASAD, SIDDHARTHA (APNC)
Entity type:Individual
Prefix:MR
First Name:SIDDHARTHA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SHADOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FORKS TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18040-6694
Mailing Address - Country:US
Mailing Address - Phone:732-801-8326
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:SPECIAL PROCEDURES
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-828-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N011085000163WM0705X
PARN603487363L00000X
NJ26NJ00120700363LA2200X
PASP010259363LA2200X
MDR221879363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner