Basic Information
| Provider Information | |||||||||
| NPI: | 1598803595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUGLISE | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 BRITTANY DR | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074703256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739511071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 CLIFTON AVE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070133518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737781134 | ||||||||
| FaxNumber: | 9736141530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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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 | 40QA01234700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.