Basic Information
| Provider Information | |||||||||
| NPI: | 1689782443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PISHAROTY | ||||||||
| FirstName: | ANIL | ||||||||
| MiddleName: | PRABHAKARAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 79 | ||||||||
| Address2: | |||||||||
| City: | BAYONNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070020079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013391700 | ||||||||
| FaxNumber: | 2013396972 | ||||||||
| Practice Location | |||||||||
| Address1: | 92-29 QUEENS BLVD 1A | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013391700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2040881 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 204088 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 08047G | 01 | NY | GROUP | OTHER |