Provider Demographics
NPI:1932231594
Name:DIGREGORIO, JONATHAN ROBERT (MPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:DIGREGORIO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1211
Mailing Address - Country:US
Mailing Address - Phone:347-351-7103
Mailing Address - Fax:718-256-8075
Practice Address - Street 1:6518 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3908
Practice Address - Country:US
Practice Address - Phone:718-256-7665
Practice Address - Fax:718-256-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018882225100000X
MA17758225100000X
NJ40QA01232200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQH4631Medicare PIN