Basic Information
| Provider Information | |||||||||
| NPI: | 1336465343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGARWAL | ||||||||
| FirstName: | NITI | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | SARDANA | ||||||||
| OtherFirstName: | NITI | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1168 PEBBLE SPRING DR | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193122147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138966370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 470 SENTRY PKWY E STE 200 | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108255800 | ||||||||
| FaxNumber: | 6103970980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | C10011774 | DE | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 208000000X | C10011774 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0201X | C10011774 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | 207K00000X | MD458507 | PA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.