Healthcare Provider Details

I. General information

NPI: 1083945422
Provider Name (Legal Business Name): MEDICHECK SPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SAINT NICHOLAS AVE
NEW YORK NY
10040-3311
US

IV. Provider business mailing address

1308 CENTENNIAL AVE SUITE 345
PISCATAWAY NJ
08854-4324
US

V. Phone/Fax

Practice location:
  • Phone: 212-795-4544
  • Fax:
Mailing address:
  • Phone: 908-222-8774
  • Fax: 908-222-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA66725
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMA66725
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number190087-1
License Number StateNY

VIII. Authorized Official

Name: DR. AJAY K. AGARWALA
Title or Position: PRESIDENT
Credential: MD
Phone: 908-222-8774