Healthcare Provider Details

I. General information

NPI: 1992181952
Provider Name (Legal Business Name): ASTHA AGRAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-18 BROADWAY # 201
FAIR LAWN NJ
07410-3016
US

IV. Provider business mailing address

22-18 BROADWAY # 201
FAIR LAWN NJ
07410-3016
US

V. Phone/Fax

Practice location:
  • Phone: 201-475-5050
  • Fax:
Mailing address:
  • Phone: 201-475-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10352000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA10352000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: