Healthcare Provider Details

I. General information

NPI: 1063322345
Provider Name (Legal Business Name): JOANNE A INDIVIGLIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 130TH ST
NEW YORK NY
10027-1813
US

IV. Provider business mailing address

236 WALNUT AVE
BOGOTA NJ
07603-1626
US

V. Phone/Fax

Practice location:
  • Phone: 201-388-3164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: