Healthcare Provider Details

I. General information

NPI: 1811180094
Provider Name (Legal Business Name): RENEE E PUGLISI CTRS, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OVERLOOK DR
LONG VALLEY NJ
07853-3129
US

IV. Provider business mailing address

17 OVERLOOK DR
LONG VALLEY NJ
07853-3129
US

V. Phone/Fax

Practice location:
  • Phone: 908-419-9484
  • Fax:
Mailing address:
  • Phone: 908-419-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License NumberCERT # 51920
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: