Healthcare Provider Details

I. General information

NPI: 1538988860
Provider Name (Legal Business Name): MARIA ELENA CIPRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CUBA HILL RD
GREENLAWN NY
11740-1624
US

IV. Provider business mailing address

1921 HENRY ST
NORTH BELLMORE NY
11710-3213
US

V. Phone/Fax

Practice location:
  • Phone: 631-628-5000
  • Fax:
Mailing address:
  • Phone: 516-557-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number032411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: