Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 40777 | NJ |
NPI | 1205990280 |
---|---|
Provider Name | Dr. Kishan C. Agarwal |
First Address | Edison, NJ 08820-2628 |
Second Address | Edison, NJ 08820-2628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3176703 | (05) | NJ |
C56504 | (02) | NJ |