Provider Demographics
NPI:1457992067
Name:IGNERI, TAYLOR CHRISTY
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTY
Last Name:IGNERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2696
Mailing Address - Country:US
Mailing Address - Phone:718-816-3579
Mailing Address - Fax:718-442-5024
Practice Address - Street 1:400 LAKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2696
Practice Address - Country:US
Practice Address - Phone:718-816-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty