Provider Demographics
NPI:1396787453
Name:SINGH, PREMPAL (MD)
Entity type:Individual
Prefix:MR
First Name:PREMPAL
Middle Name:
Last Name:SINGH
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 1:63 MELLOW LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6324
Mailing Address - Country:US
Mailing Address - Phone:631-463-1175
Mailing Address - Fax:516-420-8800
Practice Address - Street 1:720 BUSHWICK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2519
Practice Address - Country:US
Practice Address - Phone:718-455-3000
Practice Address - Fax:516-420-8800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776989Medicaid
NY26N891Medicare ID - Type Unspecified
NY01776989Medicaid