Provider Demographics
NPI:1972150258
Name:IMBURGIA, LUIGINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LUIGINA
Middle Name:MARIE
Last Name:IMBURGIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LUIGINA
Other - Middle Name:MARIE
Other - Last Name:CISTERNINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:846 SHELDON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2328
Mailing Address - Country:US
Mailing Address - Phone:917-751-0872
Mailing Address - Fax:
Practice Address - Street 1:846 SHELDON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2328
Practice Address - Country:US
Practice Address - Phone:917-751-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse