| Doctor Name: | MS. JENNY T. BAGEN |
| NPI Number: | 1184647505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F400997-1 |
| Business Practice Address: | 571 Terrace Blvd Suite 201 Depew, NY - 140433610 |
| Business Phone Number: | 7166856730 |
| Business Fax Number: | 7164070570 |
| Mailing Address: | 571 Terrace Blvd, Suite 201 DEPEW |
| State: | NY |
| Postal Code: | 140433610 |
| Phone Number: | 7166856730 |
| Fax Number: | 7164070570 |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F400997-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |