Provider Demographics
NPI:1679877583
Name:PRASAD, JAI (MBBS)
Entity type:Individual
Prefix:DR
First Name:JAI
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESTCHESTER PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3434
Mailing Address - Country:US
Mailing Address - Phone:914-948-8448
Mailing Address - Fax:914-948-0351
Practice Address - Street 1:4 WESTCHESTER PARK DR FL 4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3434
Practice Address - Country:US
Practice Address - Phone:914-948-8448
Practice Address - Fax:914-948-0351
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60335208600000X
NY295651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157127Medicaid