Provider Demographics
NPI:1891953790
Name:MAHAL, JACQUELINE JASWANT (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JASWANT
Last Name:MAHAL
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Gender:F
Credentials:MD MBA
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Mailing Address - Street 1:1111 AMSTERDAM AVE
Mailing Address - Street 2:ST LUKE'S-ROOSEVELT, DEPT OF EMERGENCY MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:ST LUKE'S-ROOSEVELT, DEPT OF EMERGENCY MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-525-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY244097207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine