Provider Demographics
NPI:1003134909
Name:JAISWAL, ATISH (MD)
Entity Type:Individual
Prefix:
First Name:ATISH
Middle Name:
Last Name:JAISWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5300 HARROUN RD
Mailing Address - Street 2:# 304
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2182
Mailing Address - Country:US
Mailing Address - Phone:419-824-1100
Mailing Address - Fax:419-824-1771
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:419-824-1100
Practice Address - Fax:410-824-1771
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2015-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY272565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine