Basic Information
| Provider Information | |||||||||
| NPI: | 1982848156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGARWALA | ||||||||
| FirstName: | ASHISH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 BELLE TERRE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316890220 | ||||||||
| FaxNumber: | 6316867626 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 BELLE TERRE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316890220 | ||||||||
| FaxNumber: | 6316867626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 252470-1 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0102202375 | VA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.