Healthcare Provider Details

I. General information

NPI: 1396845822
Provider Name (Legal Business Name): VIPIN AGARWALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
JAMAICA NY
11418-2897
US

IV. Provider business mailing address

80 MARCUS DR
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6000
  • Fax:
Mailing address:
  • Phone: 631-391-7700
  • Fax: 631-454-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number224110
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: