Provider Demographics
NPI:1780649608
Name:AGARWAL, ASHOKE (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:ASHOKE
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BROADWAY
Mailing Address - Street 2:STE 1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514
Mailing Address - Country:US
Mailing Address - Phone:973-684-8617
Mailing Address - Fax:973-523-6037
Practice Address - Street 1:715 BROADWAY
Practice Address - Street 2:STE 1
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514
Practice Address - Country:US
Practice Address - Phone:973-684-8617
Practice Address - Fax:973-523-6037
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38759207R00000X, 207RC0000X, 207RI0011X
NJ25MA038759002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8430306Medicaid
PP007OtherOXFORD
OK4756OtherHEALTH NET
48764OtherAETNA
1K6457OtherHEALTH NET
C04660Medicare UPIN
OK4756OtherHEALTH NET
PP007OtherOXFORD
NJ010875Medicare PIN