Provider Demographics
NPI:1316109366
Name:PROKURAT, VAL (DO)
Entity type:Individual
Prefix:
First Name:VAL
Middle Name:
Last Name:PROKURAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST UNIT 37
Mailing Address - Street 2:
Mailing Address - City:TENNENT
Mailing Address - State:NJ
Mailing Address - Zip Code:07763-8001
Mailing Address - Country:US
Mailing Address - Phone:800-920-9928
Mailing Address - Fax:800-615-9936
Practice Address - Street 1:107 MONMOUTH ROAD
Practice Address - Street 2:STE 102
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:201-996-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08404300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery