Provider Demographics
NPI:1437412939
Name:VIGILANTE DILORENZO, DARLA (MS)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:
Last Name:VIGILANTE DILORENZO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:
Other - Last Name:VIGILANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3216 215TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1629
Mailing Address - Country:US
Mailing Address - Phone:718-428-5188
Mailing Address - Fax:
Practice Address - Street 1:3216 215TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1629
Practice Address - Country:US
Practice Address - Phone:718-428-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1124468252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency