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General NPI Number Information
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NPI Number | 1134639461
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Entity Type | Organization
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Legal Business Name | OUR DOCTOR IN THE HOUSE LLC
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Dates
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Enumeration Date | 09/30/2017
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Last Update Date | 09/30/2017
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Provider Practice Location Address
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Address Line | 400 ROUTE 10 W STE 1AND2
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City | RANDOLPH
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State | NJ
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Zip | 07869-2104
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Country | US
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Telephone | 973-891-1321
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Fax | 973-206-5049
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Provider Business Mailing Address
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Address Line | 14 BRYCE WAY
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City | MORRIS PLAINS
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State | NJ
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Zip | 07950-2545
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Country | US
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Telephone | 973-891-1321
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Fax | 973-206-5049
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PREMA PRASAD
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Credential | MD
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Telephone | 973-979-1536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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