Provider Demographics
NPI:1639189723
Name:DEGREGORIO, DONNA JEAN (RPAC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:DEGREGORIO
Suffix:
Gender:F
Credentials:RPAC
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Mailing Address - Street 1:1080 SUNRISE HWY
Mailing Address - Street 2:MAXINE S POSTAL TRICOMMUNITY HEALTH CENTER
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-854-1008
Mailing Address - Fax:631-854-1031
Practice Address - Street 1:1080 SUNRISE HWY
Practice Address - Street 2:MAXINE S POSTAL TRICOMMUNITY HEALTH CENTER
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-854-1008
Practice Address - Fax:631-854-1031
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0052301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91014Medicare UPIN
DG00F45710Medicare ID - Type Unspecified