Healthcare Provider Details

I. General information

NPI: 1265644785
Provider Name (Legal Business Name): SUSAN DIGREGORIO R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 COUNTY COURTHOUSE ROAD
GARDEN CITY PARK NY
11404-5222
US

IV. Provider business mailing address

73 COUNTY COURTHOUSE ROAD
GARDEN CITY PARK NY
11404-5222
US

V. Phone/Fax

Practice location:
  • Phone: 516-967-3511
  • Fax: 516-414-3745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044090
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number044090
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number044090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: