Provider Demographics
NPI:1235966896
Name:WAGLE, ABHISHESH (MD)
Entity type:Individual
Prefix:
First Name:ABHISHESH
Middle Name:
Last Name:WAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 PELHAM PKWY S APT 614
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1137
Mailing Address - Country:US
Mailing Address - Phone:646-639-5157
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S BLDG 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1197
Practice Address - Country:US
Practice Address - Phone:718-918-7901
Practice Address - Fax:718-918-8364
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program