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General NPI Number Information
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NPI Number | 1366411084
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Entity Type | Individual
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Provider Name | ELIZABETH K MAMMEN-PRASAD MD
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Gender | Female
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 UNION AVE SUITE# 603
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City | IRVINGTON
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State | NJ
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Zip | 07111-3262
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Country | US
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Telephone | 973-399-9250
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Fax | 732-252-6634
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Provider Business Mailing Address
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Address Line | 50 UNION AVE SUITE#603
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City | IRVINGTON
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State | NJ
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Zip | 07111-3262
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Country | US
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Telephone | 973-399-9250
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Fax | 732-252-6634
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 25MA05474200
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License Number State | NJ
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