Basic Information
| Provider Information | |||||||||
| NPI: | 1982953956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | PRABIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 ENGLE ST | ||||||||
| Address2: | APT 4K | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076312426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014179613 | ||||||||
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| Practice Location | |||||||||
| Address1: | 267 GRANT ST | ||||||||
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| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 07/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NJ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 052810 | CT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 052810 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.