Provider Demographics
NPI:1962296590
Name:PRAKASH, ANJALI
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 GRAND ST APT 4305
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4794
Mailing Address - Country:US
Mailing Address - Phone:610-500-6226
Mailing Address - Fax:
Practice Address - Street 1:200 VARICK ST RM 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4893
Practice Address - Country:US
Practice Address - Phone:212-620-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine