Healthcare Provider Details

I. General information

NPI: 1710482625
Provider Name (Legal Business Name): AKSHAR JAGLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 NORTH RD STE 201S
POUGHKEEPSIE NY
12601-1173
US

IV. Provider business mailing address

19040 EDMONTON DR
BROOKFIELD WI
53045-3841
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-4400
  • Fax:
Mailing address:
  • Phone: 414-315-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number328129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: