Provider Demographics
NPI:1316403249
Name:DIGENNARO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIGENNARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GILENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1831
Mailing Address - Country:US
Mailing Address - Phone:516-808-1992
Mailing Address - Fax:
Practice Address - Street 1:133 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558
Practice Address - Country:US
Practice Address - Phone:516-808-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1305081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist