Individual
DR. SIDDHARTH PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 RICHMOND AVE STE 1A, STATEN ISLAND, NY 10314-3915
(718) 494-0800
Mailing address
222 E 68TH ST, NEW YORK, NY 10065-6001
(212) 879-4488
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
243250
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02920607
—
NY
Enumeration date
05/17/2007
Last updated
01/19/2023
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