MEDICARE: DR. ROY PRASHAD D.O.

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	207RR0500X	Rheumatology Physician	210837	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	:	1760473573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY PRASHAD D.O.

Provider Business Mailing Address
First Line	:	31 MAIN RD
Second Line	:	SUITE 1
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-727-0565
Fax Number	:	631-727-2789

Provider Business Practice Location Address
First Line	:	31 MAIN RD
Second Line	:	SUITE 1
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-727-0565
Fax Number	:	631-727-2789

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	04/10/2008

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