Individual
PRACHI GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2015 GRAND CONCOURSE, BRONX, NY 10453
(718) 299-7295
Mailing address
1434 WILLIAMSBRIDGE RD, BRONX, NY 10461-2507
(718) 618-0401
(347) 479-1303
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
Primary
291597
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/20/2014
Last updated
06/15/2021
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