MEDICARE: YASMINE BAGLIERI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	40QB00370000	NJ

General Provider Information

NPI Number	:	1912674052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMINE BAGLIERI

Provider Business Mailing Address
First Line	:	64 VANDERVEER AVE
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2539
Country	:	US
Telephone Number	:	908-581-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 SPRUCE ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07501-1720
Country	:	US
Telephone Number	:	973-832-0658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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Directions to “ YASMINE BAGLIERI ” Practice Location

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