Healthcare Provider Details

I. General information

NPI: 1013054048
Provider Name (Legal Business Name): PAUL ANTHONY DIGIOVANNI OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

3411 AVENUE U
BROOKLYN NY
11234-5102
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0200
  • Fax: 718-981-1431
Mailing address:
  • Phone: 917-509-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011619-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: