Provider Demographics
NPI:1104163385
Name:LATPATE, PRASHANT
Entity type:Individual
Prefix:
First Name:PRASHANT
Middle Name:
Last Name:LATPATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N BROADWAY STE 310
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1311
Mailing Address - Country:US
Mailing Address - Phone:914-207-1161
Mailing Address - Fax:914-207-1162
Practice Address - Street 1:970 N BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-207-1161
Practice Address - Fax:914-207-1162
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03584049Medicaid