Provider Demographics
NPI:1417318379
Name:JENNY T BAGEN
Entity Type:Organization
Organization Name:JENNY T BAGEN
Other - Org Name:TRANSIT PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIC NP AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:BAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:716-706-5921
Mailing Address - Street 1:4711 TRANSIT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4888
Mailing Address - Country:US
Mailing Address - Phone:716-706-5921
Mailing Address - Fax:716-706-5923
Practice Address - Street 1:4711 TRANSIT RD STE 3
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4888
Practice Address - Country:US
Practice Address - Phone:716-706-5921
Practice Address - Fax:716-706-5923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JT BAGEN ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400997163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty