Provider Demographics
NPI:1952614661
Name:SANJEEV AGARWAL MD PC
Entity Type:Organization
Organization Name:SANJEEV AGARWAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-888-9778
Mailing Address - Street 1:13621 ROOSEVELT AVE
Mailing Address - Street 2:STE 409
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5507
Mailing Address - Country:US
Mailing Address - Phone:718-888-9778
Mailing Address - Fax:718-799-5360
Practice Address - Street 1:13621 ROOSEVELT AVE
Practice Address - Street 2:STE 409
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5507
Practice Address - Country:US
Practice Address - Phone:718-888-9778
Practice Address - Fax:718-799-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243989174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty