MEDICARE: DR. KISHORE AGRAWAL

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	208600000X	Surgery Physician	146200	NY

General Provider Information

NPI Number	:	1679540603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHORE AGRAWAL

Provider Business Mailing Address
First Line	:	4287 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6241
Country	:	US
Telephone Number	:	718-948-1273
Fax Number	:	718-984-6932

Provider Business Practice Location Address
First Line	:	4287 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6241
Country	:	US
Telephone Number	:	718-948-1273
Fax Number	:	718-984-6932

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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