Provider Demographics
NPI:1982848156
Name:AGARWALA, ASHISH (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:
Last Name:AGARWALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 BELLE TERRE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2316
Mailing Address - Country:US
Mailing Address - Phone:631-689-0220
Mailing Address - Fax:631-686-7626
Practice Address - Street 1:625 BELLE TERRE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2316
Practice Address - Country:US
Practice Address - Phone:631-689-0220
Practice Address - Fax:631-686-7626
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY252470-1208600000X
VA0102202375208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery