Pankaj Haribhai Agrawal, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MA036575 Issued in NJ

Practice address

5615 Westfield Ave
Pennsauken, NJ 08110-1836

Phone

(856) 488-1415

Fax

(856) 488-1416

NPI assigned

Jun 2, 2008

Last updated

Jun 2, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lickfield Medical Associates

  • Family Medicine Physician
  • Pennsauken, NJ
  • NPI 1073698957
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1962661215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 WESTFIELD AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081101836",
            "telephone_number": "856-488-1415",
            "fax_number": "856-488-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 WESTFIELD AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081101836",
            "telephone_number": "856-488-1415",
            "fax_number": "856-488-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRAWAL",
        "first_name": "PANKAJ",
        "middle_name": "HARIBHAI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MA036575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6889204",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmanuella Adeniyi-Daniels, RBT
• Advanced Chiropractic Center, PA
• Advocare , LLC (Advocare Unity Health Center)
• Advocare, LLC (Advocare Cohen Family Medicine)
• Aging With Comfort NJ Inc
• Rashid Ahmad, M.D.
• Esther Nyamekye Aidoo
• Kevin Aikens
• Thaha Mymona Alam
• Ali Auto LLC

• Family Medicine Physician in Pennsauken, NJ
• Providers in Pennsauken, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.