Provider Demographics
NPI:1467945733
Name:NAGLIERI, ELISSA J (PA)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:J
Last Name:NAGLIERI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 ROUTE 202/206 STE 104
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1763
Mailing Address - Country:US
Mailing Address - Phone:908-450-7002
Mailing Address - Fax:
Practice Address - Street 1:757 ROUTE 202/206 STE 104
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1763
Practice Address - Country:US
Practice Address - Phone:908-450-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00491500OtherSTATE MEDICAL LICENSE