Healthcare Provider Details

I. General information

NPI: 1831647254
Provider Name (Legal Business Name): THOMAS MICHAEL CIPRIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21273 26TH AVE
BAYSIDE NY
11360-1943
US

IV. Provider business mailing address

25046 42ND AVE.
LITTLE NECK NY
11363
US

V. Phone/Fax

Practice location:
  • Phone: 718-747-2019
  • Fax:
Mailing address:
  • Phone: 718-224-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: