Provider Demographics
NPI:1902074842
Name:EAST END RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:EAST END RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASHAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-727-0565
Mailing Address - Street 1:54 COMMERCE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4454
Mailing Address - Country:US
Mailing Address - Phone:631-727-0565
Mailing Address - Fax:631-727-2789
Practice Address - Street 1:54 COMMERCE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4454
Practice Address - Country:US
Practice Address - Phone:631-727-0565
Practice Address - Fax:631-727-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210837207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH11202Medicare UPIN
NYWXWQX1Medicare PIN