Provider Demographics
NPI:1275959231
Name:GAGLANI, JAY RAJESH (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:RAJESH
Last Name:GAGLANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6264 TIMBERSIDE DR
Mailing Address - Street 2:APARTMENT 4143
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4515
Mailing Address - Country:US
Mailing Address - Phone:614-404-7792
Mailing Address - Fax:
Practice Address - Street 1:2213 FRANKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620
Practice Address - Country:US
Practice Address - Phone:419-251-4554
Practice Address - Fax:419-251-6795
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.012711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program