1316252414 NPI number — SANJAY AGARWAL PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1316252414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316252414 NPI number — SANJAY AGARWAL PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJAY AGARWAL PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1316252414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 MONTAGUE EXPY STE 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILPITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95035-6885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-942-0300
Provider Business Mailing Address Fax Number:
408-890-7298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 MONTAGUE EXPY STE 218
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILPITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95035-6885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-942-0300
Provider Business Practice Location Address Fax Number:
408-890-7298
Provider Enumeration Date:
08/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AGARWAL
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
CEO AND DIRECTOR
Authorized Official Telephone Number:
408-942-0300

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  A104257 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS1200X , with the licence number: A104257 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)