Provider Demographics
NPI:1639328594
Name:PUGLIESE, LILY (CA)
Entity Type:Individual
Prefix:MS
First Name:LILY
Middle Name:
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:CA
Other - Prefix:MS
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:PUGLIESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:610 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1244
Mailing Address - Country:US
Mailing Address - Phone:973-320-5120
Mailing Address - Fax:973-320-5120
Practice Address - Street 1:610 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1244
Practice Address - Country:US
Practice Address - Phone:973-320-5120
Practice Address - Fax:973-320-5120
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003916-1171100000X
NJ25MZ00065900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist