1053434860 NPI number — DR. ANKUR PRAKASH D.C.

Table of content: DR. ANKUR PRAKASH D.C. (NPI 1053434860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053434860 NPI number — DR. ANKUR PRAKASH D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRAKASH
Provider First Name:
ANKUR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1053434860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 LAKE BOONE TRL
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-7529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-926-8890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W 78TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10024-6755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-579-2858
Provider Business Practice Location Address Fax Number:
212-579-2853
Provider Enumeration Date:
04/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X010915 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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