Healthcare Provider Details

I. General information

NPI: 1396991717
Provider Name (Legal Business Name): REGINA MARGARET DE WITT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MAIN ST
BABYLON NY
11702-3435
US

IV. Provider business mailing address

181 W MAIN ST
BABYLON NY
11702-3435
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-2300
  • Fax:
Mailing address:
  • Phone: 631-422-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number355159-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: