1427811504 NPI number — SHANKAR PRASAD YADAV M.D.

Table of content: SHANKAR PRASAD YADAV M.D. (NPI 1427811504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427811504 NPI number — SHANKAR PRASAD YADAV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YADAV
Provider First Name:
SHANKAR
Provider Middle Name:
PRASAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1427811504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/06/2024
NPI Reactivation Date:
10/25/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
269-01 76TH AVENUE
Provider Second Line Business Mailing Address:
C-LEVEL ROOM C028
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-470-3449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269-01 76TH AVE, COHEN CHILDREN'S MEDICAL CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-3449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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