Healthcare Provider Details

I. General information

NPI: 1497744635
Provider Name (Legal Business Name): PRABHAT AHLUWALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BURWELL ST
LITTLE FALLS NY
13365-1725
US

IV. Provider business mailing address

PO BOX 1023
LITTLE FALLS NY
13365-1023
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-1111
  • Fax: 315-823-1295
Mailing address:
  • Phone: 315-525-3588
  • Fax: 315-823-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number154104-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: