Provider Demographics
NPI:1437138336
Name:DIGIACCO, ROBERT JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:DIGIACCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LYON PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-713-6618
Mailing Address - Fax:866-506-5573
Practice Address - Street 1:3 LYON PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-713-6618
Practice Address - Fax:866-506-5573
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2418392084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1437138336OtherNPI
NY02820937Medicaid
NY02820937Medicaid
NY1437138336OtherNPI
130000615Medicare ID - Type Unspecified
NYJ400003352Medicare PIN