Healthcare Provider Details

I. General information

NPI: 1730516253
Provider Name (Legal Business Name): STEVEN DONALD CILIOTTA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2013
Last Update Date: 09/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3072 JERICHO TPKE
EAST NORTHPORT NY
11731-6214
US

IV. Provider business mailing address

3072 JERICHO TPKE
EAST NORTHPORT NY
11731-6214
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-9595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number62-036-706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: