1629253760 NPI number — SUDHIR K. AGARWAL, MD

Table of content: (NPI 1629253760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629253760 NPI number — SUDHIR K. AGARWAL, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUDHIR K. AGARWAL, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629253760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 COMMERCE BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SUCCASUNNA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07876-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-252-5480
Provider Business Mailing Address Fax Number:
973-525-5481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 COMMERCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SUCCASUNNA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07876-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-252-5480
Provider Business Practice Location Address Fax Number:
973-525-5481
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AGARWAL
Authorized Official First Name:
SUDHIR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-252-5480

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA05413900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 25MA05413900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0642606 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com