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General NPI Number Information
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NPI Number | 1508043993
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Entity Type | Organization
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Legal Business Name | K.S.PRAKASH PC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 2358 CROTONA AVE
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City | BRONX
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State | NY
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Zip | 10458-8571
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Country | US
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Telephone | 718-733-2600
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Fax | 718-562-2281
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Provider Business Mailing Address
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Address Line | 2358 CROTONA AVE
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City | BRONX
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State | NY
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Zip | 10458-8571
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Country | US
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Telephone | 718-733-2600
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Fax | 718-562-2281
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRAKASH S KANCHERLA
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Credential | M.D.
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Telephone | 718-733-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 130852
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License Number State | NY
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