Healthcare Provider Details

I. General information

NPI: 1629060355
Provider Name (Legal Business Name): PRATIMA SAVARGAONKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

4567 CROSSROADS PARK DR 2ND FLOOR
LIVERPOOL NY
13088-3589
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax:
Mailing address:
  • Phone: 315-295-2100
  • Fax: 315-295-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number218377
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number218377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: