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General NPI Number Information
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NPI Number | 1720282924
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Entity Type | Organization
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Legal Business Name | MEDIAID PC.,
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1602 SAINT NICHOLAS AVE
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City | NEW YORK
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State | NY
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Zip | 10040-3311
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Country | US
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Telephone | 212-795-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 906 OAK TREE AVE SUITE J.,
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City | SOUTH PLAINFIELD
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State | NJ
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Zip | 07080-5127
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Country | US
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Telephone | 908-222-8700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ATUL K AGARWALA
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Credential | M.D.,
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Telephone | 908-222-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA066725
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MA06158600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 1900871
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 209747-1
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License Number State | NY
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