Healthcare Provider Details

I. General information

NPI: 1689080053
Provider Name (Legal Business Name): NICOLE CIORCIARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 65TH ST
MASPETH NY
11378-2824
US

IV. Provider business mailing address

5753 65TH ST
MASPETH NY
11378-2824
US

V. Phone/Fax

Practice location:
  • Phone: 917-748-6010
  • Fax:
Mailing address:
  • Phone: 917-748-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number446035101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: