Basic Information
| Provider Information | |||||||||
| NPI: | 1801011283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAGLE | ||||||||
| FirstName: | SHARAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 GOLF PL | ||||||||
| Address2: | |||||||||
| City: | ORADELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076491215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012626522 | ||||||||
| FaxNumber: | 2015415962 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 TEANECK RD | ||||||||
| Address2: | HOLYNAME NAME HOSPITAL | ||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018333291 | ||||||||
| FaxNumber: | 2015415962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0015X | MA031494 | DC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychosomatic Medicine |
No ID Information.