Provider Demographics
NPI:1467455048
Name:AGRAWAL, ARUN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:K
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4416
Mailing Address - Country:US
Mailing Address - Phone:516-565-4789
Mailing Address - Fax:516-565-4036
Practice Address - Street 1:33 FRONT STREET
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-565-4789
Practice Address - Fax:516-565-4036
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159622208VP0014X, 207L00000X, 208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00998701Medicaid
NYA63441Medicare UPIN
NY00998701Medicaid