Provider Demographics
NPI:1801915905
Name:PRABHAT R. DAS, M.D., P.C.
Entity type:Organization
Organization Name:PRABHAT R. DAS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-370-6653
Mailing Address - Street 1:1166 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5600
Mailing Address - Country:US
Mailing Address - Phone:732-370-6653
Mailing Address - Fax:732-736-6954
Practice Address - Street 1:1166 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5600
Practice Address - Country:US
Practice Address - Phone:732-370-6653
Practice Address - Fax:732-736-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06729400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ015824Medicare ID - Type Unspecified
NJF63031Medicare UPIN