Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 272565 | NY |
NPI | 1003134909 |
---|---|
Provider Name | Atish Jaiswal |
First Address | Sylvania, OH 43560-2182 |
Second Address | West Nyack, NY 10994-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 09/01/2015 |