Provider Demographics
NPI:1427085109
Name:PRAKASH, ATUL (MD)
Entity type:Individual
Prefix:DR
First Name:ATUL
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FOREST HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2031
Mailing Address - Country:US
Mailing Address - Phone:201-791-6900
Mailing Address - Fax:973-239-2056
Practice Address - Street 1:905 ALLWOOD RD STE 103
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1946
Practice Address - Country:US
Practice Address - Phone:201-355-9974
Practice Address - Fax:201-444-1755
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62803207RC0001X
NJ25MA06280300207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6745709Medicaid
G45887Medicare UPIN