Provider Demographics
NPI:1063711968
Name:PRESTIGE FAMILY MEDICINE PA
Entity type:Organization
Organization Name:PRESTIGE FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-484-7500
Mailing Address - Street 1:701 TUSCAN DR STE 145
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3839
Mailing Address - Country:US
Mailing Address - Phone:972-484-7500
Mailing Address - Fax:972-241-4496
Practice Address - Street 1:701 TUSCAN DR STE 145
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3839
Practice Address - Country:US
Practice Address - Phone:972-484-7500
Practice Address - Fax:972-241-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty