Individual
DIANE DIVERGILIO-ANTONETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
380 WASHINGTON AVE, ROOSEVELT, NY 11575-1845
(516) 378-2000
Mailing address
52 DART ST, EAST ROCKAWAY, NY 11518-1730
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0009319
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00009319
—
NY
Enumeration date
07/29/2006
Last updated
06/08/2009
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