Provider Demographics
NPI:1427097211
Name:AGARWAL, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEARS DR STE 402
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3520
Mailing Address - Country:US
Mailing Address - Phone:201-483-9188
Mailing Address - Fax:201-483-9189
Practice Address - Street 1:1 SEARS DR STE 402
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3520
Practice Address - Country:US
Practice Address - Phone:201-483-9188
Practice Address - Fax:201-483-9189
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47162207R00000X
NJ25MA08292000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640977600Medicaid
MN640977600Medicaid