# PROSPECT MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346365905
- **Authorized official:** DR. SHAN SIVENDRA M.D. (PRESIDENT)
- **Authorized official phone:** (201) 968-1881

## Contact information

- **Practice address:** 277 PROSPECT AVE, HACKENSACK, NJ 07601-2570
- **Practice address phone:** (201) 968-1881
- **Practice address fax:** (201) 968-0330
- **Mailing address:** 277 PROSPECT AVE, UNIT LG, HACKENSACK, NJ 07601-2512
- **Mailing address phone:** (201) 968-1881
- **Mailing address fax:** (201) 968-0330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA06930200 | NJ | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 08/01/2014