Provider Demographics
NPI:1356517890
Name:LATIKA, PRAJNA
Entity type:Individual
Prefix:
First Name:PRAJNA
Middle Name:
Last Name:LATIKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TEMPLE STREET
Mailing Address - Street 2:APT 1
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528
Mailing Address - Country:US
Mailing Address - Phone:940-435-9310
Mailing Address - Fax:
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:10TH FLOOR,BRONX LEBANON HOSPITAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-960-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine