Provider Demographics
NPI:1043687585
Name:JAGDE, GWEN (MS EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:
Last Name:JAGDE
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1417
Mailing Address - Country:US
Mailing Address - Phone:914-329-8061
Mailing Address - Fax:914-674-4535
Practice Address - Street 1:12 MORNINGSIDE RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1417
Practice Address - Country:US
Practice Address - Phone:914-329-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY887600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist