Basic Information
| Provider Information | |||||||||
| NPI: | 1043448467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGLEY | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | CHANIN | ||||||||
| OtherFirstName: | RENEE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 157 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088091337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086845800 | ||||||||
| FaxNumber: | 9086845606 | ||||||||
| Practice Location | |||||||||
| Address1: | 531 ROUTE 57 E | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078822440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088351600 | ||||||||
| FaxNumber: | 9088351601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01177300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.