Provider Demographics
NPI:1518231075
Name:DAGLI, SANATKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANATKUMAR
Middle Name:
Last Name:DAGLI
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 1:944 N BROADWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1315
Mailing Address - Country:US
Mailing Address - Phone:914-476-1322
Mailing Address - Fax:914-476-1346
Practice Address - Street 1:944 N BROADWAY STE 108
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1315
Practice Address - Country:US
Practice Address - Phone:914-476-1322
Practice Address - Fax:914-476-1346
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00229612Medicaid