Provider Demographics
NPI:1144356817
Name:RIGOLI, VICTOR L JR (LPN)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:L
Last Name:RIGOLI
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-9149
Mailing Address - Country:US
Mailing Address - Phone:845-756-3952
Mailing Address - Fax:
Practice Address - Street 1:215 CAMP RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-9149
Practice Address - Country:US
Practice Address - Phone:845-756-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244976164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01895725Medicaid