Provider Demographics
NPI:1700816295
Name:CONIGLIO, DEBORAH (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 POLE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9670
Mailing Address - Country:US
Mailing Address - Phone:585-226-6247
Mailing Address - Fax:
Practice Address - Street 1:2150 POLE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-9670
Practice Address - Country:US
Practice Address - Phone:585-226-6247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02506738Medicaid
NYF332215OtherLICENSE
NYC99401Medicare UPIN