Healthcare Provider Details

I. General information

NPI: 1336697804
Provider Name (Legal Business Name): STEPHANIE CICALESE D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 TOWER DR SUITE 400
MIDDLETOWN NY
10941-2056
US

IV. Provider business mailing address

5306 CLARK ST
NEW WINDSOR NY
12553-8281
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-641-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037247-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: