Healthcare Provider Details

I. General information

NPI: 1801160817
Provider Name (Legal Business Name): REGINA DAZZO FOGEL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6581 HYLAN BLVD
STATEN ISLAND NY
10309-3830
US

IV. Provider business mailing address

6581 HYLAN BLVD
STATEN ISLAND NY
10309-3830
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-1526
  • Fax: 718-356-8905
Mailing address:
  • Phone: 718-984-1526
  • Fax: 718-356-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number230967-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: