Healthcare Provider Details

I. General information

NPI: 1003343393
Provider Name (Legal Business Name): ANGELA CILIBERTO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 N FRENCH RD
EAST AMHERST NY
14051-2176
US

IV. Provider business mailing address

4754 N FRENCH RD
EAST AMHERST NY
14051-2176
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-8815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: