Healthcare Provider Details

I. General information

NPI: 1477761641
Provider Name (Legal Business Name): BARBARA SUZY DIGGLE-FOX R.N., N.P., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HAUPPAUGE RD GURWIN JEWISH GERIATRIC CENTER, EMPLOYEE HEALTH
COMMACK NY
11725-4403
US

IV. Provider business mailing address

4039 W GILGO BCH
WEST GILGO BEACH NY
11702-4615
US

V. Phone/Fax

Practice location:
  • Phone: 631-921-0838
  • Fax: 631-221-9733
Mailing address:
  • Phone: 631-221-9733
  • Fax: 631-221-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number349443-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300525-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340013-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: