Basic Information
| Provider Information | |||||||||
| NPI: | 1922063502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAEGELE | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5170 US ROUTE 60 E | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043994422 | ||||||||
| FaxNumber: | 3043994433 | ||||||||
| Practice Location | |||||||||
| Address1: | 6007 ROUTE 60 EAST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047339270 | ||||||||
| FaxNumber: | 3047339087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 20083 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 6700669000 | 05 | WV | MEDICAID | 2178405 | 05 | OH | MEDICAID | 64015936 | 05 | KY | MEDICAID |