Provider Demographics
NPI:1609085711
Name:INGENITO, PHILIP ALLAN
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALLAN
Last Name:INGENITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16310 CROSSBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3740
Mailing Address - Country:US
Mailing Address - Phone:917-690-0378
Mailing Address - Fax:
Practice Address - Street 1:16310 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3740
Practice Address - Country:US
Practice Address - Phone:917-690-0378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor