Provider Demographics
NPI:1962449785
Name:AGGARWAL MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:AGGARWAL MEDICAL ASSOCIATES PA
Other - Org Name:EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-453-3937
Mailing Address - Street 1:1045 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4531
Mailing Address - Country:US
Mailing Address - Phone:321-453-3937
Mailing Address - Fax:321-452-5404
Practice Address - Street 1:1045 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4531
Practice Address - Country:US
Practice Address - Phone:321-453-3937
Practice Address - Fax:321-452-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036143207W00000X
FLME81029207W00000X
FLME71349207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH22410Medicare UPIN
FL0957740001Medicare NSC
FLA72380Medicare UPIN
FLD51279Medicare UPIN
FL39574Medicare ID - Type Unspecified