Healthcare Provider Details

I. General information

NPI: 1093824948
Provider Name (Legal Business Name): STEPHEN DANIEL CICALESE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 STEWART AVE
GARDEN CITY NY
11530-4706
US

IV. Provider business mailing address

25 PARKSIDE AVE
MILLER PLACE NY
11764-2722
US

V. Phone/Fax

Practice location:
  • Phone: 516-739-7733
  • Fax: 516-739-1859
Mailing address:
  • Phone: 631-807-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026984-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: