Healthcare Provider Details

I. General information

NPI: 1245236207
Provider Name (Legal Business Name): KIRA ANTONIA GERACI-CIARDULLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HARRISON AVE STE 304
MAMARONECK NY
10543-3151
US

IV. Provider business mailing address

1600 HARRISON AVE STE 304
MAMARONECK NY
10543-3151
US

V. Phone/Fax

Practice location:
  • Phone: 914-777-1179
  • Fax: 914-777-1262
Mailing address:
  • Phone: 914-777-1179
  • Fax: 914-777-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number146408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: