Provider Demographics
NPI:1598645822
Name:PREFRONTAL PATHWAYS, INC
Entity type:Organization
Organization Name:PREFRONTAL PATHWAYS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERIATRIC PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:NUPUR
Authorized Official - Middle Name:GODBOLE
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-388-8711
Mailing Address - Street 1:9222 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5422
Mailing Address - Country:US
Mailing Address - Phone:813-388-8711
Mailing Address - Fax:239-356-3752
Practice Address - Street 1:9222 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5422
Practice Address - Country:US
Practice Address - Phone:813-388-8711
Practice Address - Fax:239-356-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty