Provider Demographics
NPI:1912927658
Name:AGGARWAL, SANJAY K (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:K
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4403
Mailing Address - Country:US
Mailing Address - Phone:203-865-3880
Mailing Address - Fax:203-624-5609
Practice Address - Street 1:1427 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4403
Practice Address - Country:US
Practice Address - Phone:203-865-3880
Practice Address - Fax:203-624-5609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG74856Medicare UPIN
CTC03455Medicare ID - Type Unspecified