Healthcare Provider Details

I. General information

NPI: 1164183422
Provider Name (Legal Business Name): ABHISHEK AGARWAL DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 20TH AVE
WHITESTONE NY
11357-3046
US

IV. Provider business mailing address

3010 41ST AVE
LONG ISLAND CITY NY
11101-2814
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-1212
  • Fax:
Mailing address:
  • Phone: 518-545-4753
  • Fax: 725-433-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABHISHEK AGARWAL
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: DO
Phone: 518-545-4753