MEDICARE: DR. AJAY KUMAR AGARWALA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MA066725	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366415465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJAY KUMAR AGARWALA M.D.

Provider Business Mailing Address
First Line	:	257-12 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004
Country	:	US
Telephone Number	:	718-343-3800
Fax Number	:	914-303-5004

Provider Business Practice Location Address
First Line	:	257-12 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-343-3800
Fax Number	:	914-303-5004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	08/17/2018

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