Basic Information
| Provider Information | |||||||||
| NPI: | 1356517890 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LATIKA | ||||||||
| FirstName: | PRAJNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 TEMPLE STREET | ||||||||
| Address2: | APT 1 | ||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404359310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | 10TH FLOOR,BRONX LEBANON HOSPITAL CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 269538 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.