Provider Demographics
NPI:1639364359
Name:SHASHI K AGARWAL, MD PA
Entity type:Organization
Organization Name:SHASHI K AGARWAL, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-676-1234
Mailing Address - Street 1:198 CENTRAL AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3389
Mailing Address - Country:US
Mailing Address - Phone:973-676-1234
Mailing Address - Fax:973-676-0009
Practice Address - Street 1:198 CENTRAL AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3389
Practice Address - Country:US
Practice Address - Phone:973-676-1234
Practice Address - Fax:973-676-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 34347207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18799Medicare UPIN