Provider Demographics
NPI:1306911763
Name:PRAKASH, MEERA VENKATARAMAN (MD)
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:VENKATARAMAN
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 ORADELL AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4809
Mailing Address - Country:US
Mailing Address - Phone:201-265-1403
Mailing Address - Fax:973-890-4574
Practice Address - Street 1:169 MINNISINK RD
Practice Address - Street 2:NORTH JERSEY DEVELOPMENTAL
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1803
Practice Address - Country:US
Practice Address - Phone:973-256-1700
Practice Address - Fax:973-890-4574
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040204002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA04020400OtherSTATE LICENCE NUMBER