Provider Demographics
NPI:1194809293
Name:NAGLER, JERRY (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:NAGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EAST 77TH STREET
Mailing Address - Street 2:APT 2422
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10162
Mailing Address - Country:US
Mailing Address - Phone:212-861-1498
Mailing Address - Fax:212-861-1498
Practice Address - Street 1:407 EAST 70TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-628-7777
Practice Address - Fax:212-517-6625
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120405207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12791Medicare UPIN
315131Medicare ID - Type Unspecified