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General NPI Number Information
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NPI Number | 1811929573
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Entity Type | Organization
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Legal Business Name | S PRAKASH MD PA
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 534 AVENUE E SUITE 1-A
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City | BAYONNE
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State | NJ
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Zip | 07002-3987
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Country | US
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Telephone | 201-858-8444
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Fax | 201-858-4260
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Provider Business Mailing Address
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Address Line | 534 AVENUE E SUITE 1-A
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City | BAYONNE
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State | NJ
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Zip | 07002-3987
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Country | US
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Telephone | 201-858-8444
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Fax | 201-858-4260
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Authorized Official
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Title or Position | OWNER
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Name | DR. SASHA PRAKASH
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Credential | M.D.
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Telephone | 201-858-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MA34605
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License Number State | NJ
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