Healthcare Provider Details

I. General information

NPI: 1912835885
Provider Name (Legal Business Name): PRAVA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 QUEENS BLVD
FOREST HILLS NY
11375-5372
US

IV. Provider business mailing address

2077 LAKES EDGE DR
NEWBURGH IN
47630-8017
US

V. Phone/Fax

Practice location:
  • Phone: 812-484-8334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL JAIRATH
Title or Position: CEO
Credential: MD
Phone: 812-484-8334