Healthcare Provider Details

I. General information

NPI: 1538277017
Provider Name (Legal Business Name): CATHERINE PECORINO BAGLIERI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MANTUA PIKE
WOODBURY HEIGHTS NJ
08097-1221
US

IV. Provider business mailing address

321 WINDSOR AVE
HADDONFIELD NJ
08033-1141
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-8181
  • Fax: 856-845-8586
Mailing address:
  • Phone: 617-312-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010519
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00089200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: