Provider Demographics
NPI:1497915995
Name:TAGLIENTI, JENNA L (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:TAGLIENTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OAKLAND AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2130
Mailing Address - Country:US
Mailing Address - Phone:631-729-2140
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:125 OAKLAND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2130
Practice Address - Country:US
Practice Address - Phone:631-729-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2629882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry