Healthcare Provider Details

I. General information

NPI: 1710233952
Provider Name (Legal Business Name): PRAJITH MEPPARAMBATH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2900S
HAWTHORNE NY
10532-2194
US

IV. Provider business mailing address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4343
  • Fax:
Mailing address:
  • Phone: 914-614-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number276111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: