Provider Demographics
NPI:1083945422
Name:MEDICHECK SPECIALTY LLC
Entity Type:Organization
Organization Name:MEDICHECK SPECIALTY LLC
Other - Org Name:MEDICHECK SPECIALTY MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGARWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-222-8774
Mailing Address - Street 1:1308 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4324
Mailing Address - Country:US
Mailing Address - Phone:908-222-8774
Mailing Address - Fax:908-222-8771
Practice Address - Street 1:1602 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3311
Practice Address - Country:US
Practice Address - Phone:212-795-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66725207RC0000X, 207UN0901X
NY190087-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty