Provider Demographics
NPI:1912973140
Name:NARAYAN DAS AGRAWAL
Entity type:Organization
Organization Name:NARAYAN DAS AGRAWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYAN
Authorized Official - Middle Name:DAS
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-205-2785
Mailing Address - Street 1:PO BOX 670700
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-0700
Mailing Address - Country:US
Mailing Address - Phone:718-205-2785
Mailing Address - Fax:718-424-3436
Practice Address - Street 1:3729 72ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6126
Practice Address - Country:US
Practice Address - Phone:718-205-2785
Practice Address - Fax:718-424-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225128173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02559797Medicaid
NY06532GMedicare ID - Type Unspecified
NY07028Medicare ID - Type Unspecified