Provider Demographics
NPI:1285699041
Name:SAGAR, SUSHIL (MD,FACP,FASN)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:SAGAR
Suffix:
Gender:M
Credentials:MD,FACP,FASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MELANIE DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1436
Mailing Address - Country:US
Mailing Address - Phone:516-735-5522
Mailing Address - Fax:516-644-5385
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 17
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5711
Practice Address - Country:US
Practice Address - Phone:516-735-5522
Practice Address - Fax:516-644-5385
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202133207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707446Medicaid
G39668Medicare UPIN
NY17N891Medicare PIN
NYWEV711Medicare PIN