Healthcare Provider Details

I. General information

NPI: 1104200534
Provider Name (Legal Business Name): PRASHANT SUKHANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 SIXTH STREET NEW YORK METHODIST HOSPITAL
BROOKLYN NY
11215
US

IV. Provider business mailing address

506 6TH STREET NEW YORK METHODIST HOSPITAL
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5410
  • Fax:
Mailing address:
  • Phone: 718-780-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number058084-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: