1144285479 NPI number — DR. PREM L SAGAR M.D.,F.A.C.P.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144285479 NPI number — DR. PREM L SAGAR M.D.,F.A.C.P.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SAGAR

Provider First Name:

PREM

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.,F.A.C.P.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1144285479

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/14/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

141 MELANIE DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EAST MEADOW

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11554-1436

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

516-735-5522

Provider Business Mailing Address Fax Number:

516-644-5385

Provider First Line Business Practice Location Address:

4250 HEMPSTEAD TPKE

Provider Second Line Business Practice Location Address:

SUITE 17

Provider Business Practice Location Address City Name:

BETHPAGE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11714-5711

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

516-735-5522

Provider Business Practice Location Address Fax Number:

516-644-5385

Provider Enumeration Date:

04/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  210715 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 210715 . This is a "HIP/VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P00157993 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01919259 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: P3090618 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: SP0715 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2590818 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 295AB1 . This is a "EMPIRE BCBS OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3C9671 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 179120 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3394510 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7475519 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 900125879 . This is a "TAX ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".