Provider Demographics
NPI:1841836525
Name:PRASAD MEDICAL PHYSICIAN P.C
Entity type:Organization
Organization Name:PRASAD MEDICAL PHYSICIAN P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKINEEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-806-8244
Mailing Address - Street 1:12 NORTHUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2615
Mailing Address - Country:US
Mailing Address - Phone:516-450-0701
Mailing Address - Fax:516-822-3067
Practice Address - Street 1:894 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3618
Practice Address - Country:US
Practice Address - Phone:516-450-0701
Practice Address - Fax:516-822-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty