Provider Demographics
NPI:1295294254
Name:MAHGEREFTEH, JACKLYN SARA (DO)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:SARA
Last Name:MAHGEREFTEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8050
Mailing Address - Country:US
Mailing Address - Phone:732-244-4400
Mailing Address - Fax:732-505-2171
Practice Address - Street 1:601 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8050
Practice Address - Country:US
Practice Address - Phone:732-244-4400
Practice Address - Fax:732-505-2171
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11763200207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program