Provider Demographics
NPI:1205917804
Name:MEDFORD DIALYSIS ACCESS P.C.
Entity type:Organization
Organization Name:MEDFORD DIALYSIS ACCESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PURSHOTAM
Authorized Official - Middle Name:LAL
Authorized Official - Last Name:NAGWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-732-4600
Mailing Address - Street 1:80 HILLDALE RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-2214
Mailing Address - Country:US
Mailing Address - Phone:516-640-5656
Mailing Address - Fax:516-640-5656
Practice Address - Street 1:3241 ROUTE 112
Practice Address - Street 2:BLDG #7
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1434
Practice Address - Country:US
Practice Address - Phone:631-732-4600
Practice Address - Fax:631-732-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty