Healthcare Provider Details

I. General information

NPI: 1447747910
Provider Name (Legal Business Name): MIRIA PRASAD-PHILIP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELEN HAYES HOSPITAL 51-55 US-W
WEST HAVERSTRAW NY
10993
US

IV. Provider business mailing address

518 KINGS HWY
VALLEY COTTAGE NY
10989-1847
US

V. Phone/Fax

Practice location:
  • Phone: 845-786-4000
  • Fax:
Mailing address:
  • Phone: 845-826-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: