MEDICARE: DR. PRASUNA R NUKALAPATI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	127129	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497744841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRASUNA R NUKALAPATI

Provider Business Mailing Address
First Line	:	4673 PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5623
Country	:	US
Telephone Number	:	718-365-5413
Fax Number	:	718-364-6716

Provider Business Practice Location Address
First Line	:	4673 PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5623
Country	:	US
Telephone Number	:	718-365-5413
Fax Number	:	718-364-6716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/25/2013

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