Provider Demographics
NPI:1568039873
Name:BUGLISI, JULIET M
Entity Type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:M
Last Name:BUGLISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 EMMANS RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9042
Mailing Address - Country:US
Mailing Address - Phone:772-501-1792
Mailing Address - Fax:
Practice Address - Street 1:166 EMMANS RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9042
Practice Address - Country:US
Practice Address - Phone:772-501-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86117549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered