Healthcare Provider Details

I. General information

NPI: 1275156358
Provider Name (Legal Business Name): STEVEN THOMAS CICCONE R.T.(R)(CT)(MR)(VI)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

2266 W 6TH ST
BROOKLYN NY
11223-4621
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone: 347-220-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number570223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: