Provider Demographics
NPI:1447553565
Name:AGGARWAL, KALA (MD)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BURNING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2938
Mailing Address - Country:US
Mailing Address - Phone:201-258-4000
Mailing Address - Fax:
Practice Address - Street 1:1226 31ST AVE
Practice Address - Street 2:BASEMENT NYC DOHMH
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4814
Practice Address - Country:US
Practice Address - Phone:718-267-2104
Practice Address - Fax:718-267-2105
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 040434208000000X
NY155960-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics