Provider Demographics
NPI:1720282924
Name:MEDIAID PC.,
Entity Type:Organization
Organization Name:MEDIAID PC.,
Other - Org Name:HEALTHCHECK MEDICAL & EYE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGARWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:908-222-8700
Mailing Address - Street 1:906 OAK TREE AVE
Mailing Address - Street 2:SUITE J.,
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5127
Mailing Address - Country:US
Mailing Address - Phone:908-222-8700
Mailing Address - Fax:
Practice Address - Street 1:1602 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3311
Practice Address - Country:US
Practice Address - Phone:212-795-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066725207RC0000X
NY209747-1207RC0000X
NJMA06158600207W00000X
NY1900871207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01502661Medicaid
NY01502661Medicaid
NY01502661Medicaid
NJ01502661Medicaid