Provider Demographics
NPI:1245311794
Name:BRIGANTI, DIANE (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BRIGANTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SOUTH RD
Mailing Address - Street 2:D-102
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5978
Mailing Address - Country:US
Mailing Address - Phone:845-298-0992
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH RD
Practice Address - Street 2:D-102
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5978
Practice Address - Country:US
Practice Address - Phone:845-298-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-004760-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC3A801Medicare ID - Type Unspecified
NYC3A801Medicare UPIN