Healthcare Provider Details

I. General information

NPI: 1023589348
Provider Name (Legal Business Name): KANINGHAT PRASANTH PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 101ST AVE
OZONE PARK NY
11416-2217
US

IV. Provider business mailing address

9010 101ST AVE
OZONE PARK NY
11416-2217
US

V. Phone/Fax

Practice location:
  • Phone: 929-512-5187
  • Fax: 929-399-2430
Mailing address:
  • Phone: 929-512-5187
  • Fax: 929-399-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KANINGHAT PRASANTH
Title or Position: OWNER
Credential: MD
Phone: 929-512-5187