Healthcare Provider Details

I. General information

NPI: 1467466870
Provider Name (Legal Business Name): REGINA ATANASIO DIGIOVANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 SEGUINE AVE
STATEN ISLAND NY
10309-3906
US

IV. Provider business mailing address

392 SEGUINE AVE
STATEN ISLAND NY
10309-3906
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-2824
  • Fax: 718-226-2954
Mailing address:
  • Phone: 718-226-2824
  • Fax: 718-228-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number174373
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number174373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: