Provider Demographics
NPI:1902063860
Name:VISHWANATH AGARWAL MDPC
Entity Type:Organization
Organization Name:VISHWANATH AGARWAL MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VISHWA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-392-3350
Mailing Address - Street 1:131 COUNTRY VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1009
Mailing Address - Country:US
Mailing Address - Phone:516-775-3591
Mailing Address - Fax:
Practice Address - Street 1:4331 45TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2355
Practice Address - Country:US
Practice Address - Phone:718-392-3350
Practice Address - Fax:718-392-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty