Provider Demographics
NPI:1356064240
Name:PRASANNA SASWATHAN, PRASANTH
Entity type:Individual
Prefix:
First Name:PRASANTH
Middle Name:
Last Name:PRASANNA SASWATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 MOUNT AIRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8961
Mailing Address - Country:US
Mailing Address - Phone:601-513-0935
Mailing Address - Fax:
Practice Address - Street 1:266 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2343
Practice Address - Country:US
Practice Address - Phone:845-691-9225
Practice Address - Fax:845-691-6408
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01221501225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant