Healthcare Provider Details

I. General information

NPI: 1760744015
Provider Name (Legal Business Name): ANNE MARIE CICCIU M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 2ND AVE 11B
NEW YORK NY
10016-8639
US

IV. Provider business mailing address

510 2ND AVE 11B
NEW YORK NY
10016-8639
US

V. Phone/Fax

Practice location:
  • Phone: 212-689-5146
  • Fax:
Mailing address:
  • Phone: 212-689-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number514625931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: