Individual
PREM SHANKER MISRA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11247 QUEENS BLVD, STE 108, FOREST HILLS, NY 11375-7417
(718) 793-3838
(516) 352-2025
Mailing address
115 CHERRYWOOD DR, NEW HYDE PARK, NY 11040-2209
(516) 352-2025
(516) 352-2025
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
109522
NY
207RG0100X
Gastroenterology Physician
Primary
109522
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00194312
—
NY
01
—
89979
GHI MEDICARE
NY
Enumeration date
08/09/2005
Last updated
09/11/2025
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