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General NPI Number Information
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NPI Number | 1457526618
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Entity Type | Organization
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Legal Business Name | AGASTIN MICHAEL, MD PLLC
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 175 MEMORIAL HWY SUITE 3-1
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5635
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Country | US
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Telephone | 914-740-7620
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Fax | 914-740-7621
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Provider Business Mailing Address
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Address Line | 175 MEMORIAL HWY SUITE 3-1
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5635
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Country | US
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Telephone | 914-740-7620
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Fax | 914-740-7621
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Authorized Official
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Title or Position | OWNER
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Name | AGASTIN MICHAEL
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Credential | MD
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Telephone | 914-740-7620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 227576
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License Number State | NY
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