Healthcare Provider Details

I. General information

NPI: 1912674052
Provider Name (Legal Business Name): YASMINE BAGLIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SPRUCE ST
PATERSON NJ
07501-1720
US

IV. Provider business mailing address

64 VANDERVEER AVE
SOMERVILLE NJ
08876-2539
US

V. Phone/Fax

Practice location:
  • Phone: 973-832-0658
  • Fax:
Mailing address:
  • Phone: 908-581-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number40QB00370000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: