Healthcare Provider Details

I. General information

NPI: 1023357605
Provider Name (Legal Business Name): ATHENA THERESA BAGAIPO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 RED SCHOOL LN
PHILLIPSBURG NJ
08865-2276
US

IV. Provider business mailing address

617 ALMOND CT
FLEMINGTON NJ
08822-3141
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-7060
  • Fax: 610-335-4404
Mailing address:
  • Phone: 908-968-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00442900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 336397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: