Healthcare Provider Details

I. General information

NPI: 1245303692
Provider Name (Legal Business Name): SANATKUMAR S DAGLI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 NORTH BROADWAY SUITE 108
YONKERS NY
10701
US

IV. Provider business mailing address

944 NORTH BROADWAY SUITE 108
YONKERS NY
10701
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 Code208000000X
TaxonomyPediatrics Physician
License Number122116
License Number StateNY

VIII. Authorized Official

Name: SANATKUMAR SHANTILAR DAGLI
Title or Position: PRESIDENT
Credential: MD
Phone: 914-426-1522