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General NPI Number Information
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NPI Number | 1205917804
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Entity Type | Organization
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Legal Business Name | MEDFORD DIALYSIS ACCESS P.C.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3241 ROUTE 112 BLDG #7
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City | MEDFORD
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State | NY
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Zip | 11763-1434
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Country | US
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Telephone | 631-732-4600
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Fax | 631-732-4656
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Provider Business Mailing Address
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Address Line | 80 HILLDALE RD
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City | ALBERTSON
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State | NY
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Zip | 11507-2214
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Country | US
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Telephone | 516-640-5656
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Fax | 516-640-5656
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. PURSHOTAM LAL NAGWANI
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Credential | M.D.
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Telephone | 631-732-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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