Provider Demographics
NPI:1205158011
Name:JAGGERNAUTH, BHAGWATTIE D
Entity type:Individual
Prefix:
First Name:BHAGWATTIE
Middle Name:D
Last Name:JAGGERNAUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 LINCOLN PL
Mailing Address - Street 2:APT.2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4432
Mailing Address - Country:US
Mailing Address - Phone:917-573-7447
Mailing Address - Fax:
Practice Address - Street 1:670 LINCOLN PL
Practice Address - Street 2:APT.2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4432
Practice Address - Country:US
Practice Address - Phone:917-573-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292864-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse