1821034141 NPI number — DR. PREMA PRASAD M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821034141 NPI number — DR. PREMA PRASAD M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PRASAD

Provider First Name:

PREMA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821034141

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/18/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

400 ROUTE 10

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RANDOLPH

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07869-2104

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

973-891-1321

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

3175 ROUTE 10

Provider Second Line Business Practice Location Address:

SUITE 500

Provider Business Practice Location Address City Name:

DENVILLE

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07834-3491

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

973-537-1400

Provider Business Practice Location Address Fax Number:

973-366-1648

Provider Enumeration Date:

06/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  MA06191400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 5917459 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1786357 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0857907000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "GREATHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 7163304 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: P679666 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "FIRSTHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 200442873 . This is a "UNITEDHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".