Healthcare Provider Details

I. General information

NPI: 1518231075
Provider Name (Legal Business Name): SANATKUMAR DAGLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 N BROADWAY STE 108
YONKERS NY
10701-1315
US

IV. Provider business mailing address

944 N BROADWAY STE 108
YONKERS NY
10701-1315
US

V. Phone/Fax

Practice location:
  • Phone: 914-476-1322
  • Fax: 914-476-1346
Mailing address:
  • Phone: 914-476-1322
  • Fax: 914-476-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number122116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: