Provider Demographics
NPI:1992846497
Name:JT BAGEN ENTERPRISES INC
Entity Type:Organization
Organization Name:JT BAGEN ENTERPRISES INC
Other - Org Name:TRANSIT PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:716-706-5921
Mailing Address - Street 1:4721 TRANSIT ROAD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3610
Mailing Address - Country:US
Mailing Address - Phone:716-706-5921
Mailing Address - Fax:716-706-5923
Practice Address - Street 1:4721 TRANSIT ROAD
Practice Address - Street 2:SUITE 23
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14043
Practice Address - Country:US
Practice Address - Phone:716-706-5921
Practice Address - Fax:716-706-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400997-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1013OtherOTHER PROVIDER MEDICARE IDENTIFIER
NYBA1013OtherOTHER PROVIDER MEDICARE IDENTIFIER