Provider Demographics
NPI:1982675633
Name:AGARWAL, SMITA (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ROUTE 202/206
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1758
Mailing Address - Country:US
Mailing Address - Phone:908-393-9755
Mailing Address - Fax:908-393-9757
Practice Address - Street 1:745 ROUTE 202/206
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1758
Practice Address - Country:US
Practice Address - Phone:908-393-9755
Practice Address - Fax:908-393-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07870700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I39551Medicare UPIN
NJ094039NR4Medicare ID - Type Unspecified
NJ033830Medicare ID - Type UnspecifiedGROUP