1447828843 NPI number — MRS. SMRUTI PRASAD PT

Table of content: MRS. SMRUTI PRASAD PT (NPI 1447828843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447828843 NPI number — MRS. SMRUTI PRASAD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRASAD
Provider First Name:
SMRUTI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMRUTIPRAVA
Provider Other First Name:
PRIYADARSINEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447828843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 WEST AMARILLO BLVD. APT 515
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-567-7877
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRAL VALLEY ORTHOPEDICS & REHABILITATION
Provider Second Line Business Practice Location Address:
244 BROADWAY
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-784-4131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2021

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: 225100000X , with the licence number:  044020 , 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)