Provider Demographics
NPI:1780722744
Name:AMIYA PRASAD, MD, PC
Entity type:Organization
Organization Name:AMIYA PRASAD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-693-0700
Mailing Address - Street 1:PO BOX 7123
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-7123
Mailing Address - Country:US
Mailing Address - Phone:516-742-4636
Mailing Address - Fax:718-479-0529
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE206
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-742-4636
Practice Address - Fax:516-742-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179440207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557840Medicaid
NY94T641Medicare ID - Type Unspecified
NY01557840Medicaid