Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 224110 | NY |
N | 208000000X | Pediatrician | 224110 | NY |
NPI | 1396845822 |
---|---|
Provider Name | Dr. Vipin Agarwalla |
First Address | Melville, NY 11747-4230 |
Second Address | Jamaica, NY 11418-2897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02278224 | (05) | NY |
H75117 | (02) | NY |