Healthcare Provider Details

I. General information

NPI: 1144247222
Provider Name (Legal Business Name): JEFFREY W CIOLINO OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EDGEWATER DR
NORWOOD MA
02062-4642
US

IV. Provider business mailing address

143 CHARDONNAY DR
EAST QUOGUE NY
11942-3829
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-0900
  • Fax: 631-422-0900
Mailing address:
  • Phone: 631-278-0665
  • Fax: 631-422-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0063691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: