Provider Demographics
NPI:1912674052
Name:BAGLIERI, YASMINE
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:
Last Name:BAGLIERI
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 1:64 VANDERVEER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2539
Mailing Address - Country:US
Mailing Address - Phone:908-581-2081
Mailing Address - Fax:
Practice Address - Street 1:97 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1720
Practice Address - Country:US
Practice Address - Phone:973-832-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB003700002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine