1487702718 NPI number — A & S KHANDELWAL MD INC

Table of content: (NPI 1487702718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487702718 NPI number — A & S KHANDELWAL MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & S KHANDELWAL MD INC
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:
1487702718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 E WASHINGTON ST STE 2F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-2181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-723-7999
Provider Business Mailing Address Fax Number:
330-764-9907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 E WASHINGTON ST STE 2F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-2181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-723-7999
Provider Business Practice Location Address Fax Number:
330-764-9907
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHANDELWAL
Authorized Official First Name:
ANAND
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-723-7999

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  35-054767K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 051224K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0880702 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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