Healthcare Provider Details

I. General information

NPI: 1285944108
Provider Name (Legal Business Name): PRAKASHCHANDRA PARIKH PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CARLETON AVE STE 6 SUITE 6
ISLIP TERRACE NY
11752-2236
US

IV. Provider business mailing address

111 CARLETON AVE STE 6 SUITE 6
ISLIP TERRACE NY
11752-2236
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-0300
  • Fax:
Mailing address:
  • Phone: 631-581-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DONNA FRASER
Title or Position: MANAGER
Credential:
Phone: 631-581-0300