Basic Information
| Provider Information | |||||||||
| NPI: | 1598706079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | PRAKASH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX A | ||||||||
| Address2: | ASSURE ANESTHESIA | ||||||||
| City: | NORTH BELLMORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117100745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007201664 | ||||||||
| FaxNumber: | 2077532020 | ||||||||
| Practice Location | |||||||||
| Address1: | 2475 SAINT RAYMONDS AVE | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184307473 | ||||||||
| FaxNumber: | 7184307336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 201068 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01737815 | 05 | NY | MEDICAID | P00154679 | 01 | RAILROAD MEDICARE | OTHER |