Provider Demographics
NPI:1245303692
Name:SANATKUMAR S DAGLI MD PC
Entity type:Organization
Organization Name:SANATKUMAR S DAGLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANATKUMAR
Authorized Official - Middle Name:SHANTILAR
Authorized Official - Last Name:DAGLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-426-1522
Mailing Address - Street 1:944 NORTH BROADWAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-476-1322
Mailing Address - Fax:914-476-1346
Practice Address - Street 1:944 NORTH BROADWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-476-1322
Practice Address - Fax:914-476-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0056569OtherGHI
NYA0694OtherHEALTHNET
NY00229616Medicaid
B20645Medicare UPIN