Provider Demographics
NPI:1174679336
Name:YAGNIK, DRUMILKUMAR L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DRUMILKUMAR
Middle Name:L
Last Name:YAGNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 US HIGHWAY 46
Mailing Address - Street 2:STE 10
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1814
Mailing Address - Country:US
Mailing Address - Phone:973-890-8811
Mailing Address - Fax:973-890-8811
Practice Address - Street 1:4446 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2939
Practice Address - Country:US
Practice Address - Phone:212-567-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00810004Medicaid