Healthcare Provider Details

I. General information

NPI: 1720302219
Provider Name (Legal Business Name): JEANETTE CIGLIANO MA CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DARWIN DR
NORTH MERRICK NY
11566-1414
US

IV. Provider business mailing address

4 DARWIN DR
NORTH MERRICK NY
11566-1414
US

V. Phone/Fax

Practice location:
  • Phone: 516-783-3009
  • Fax:
Mailing address:
  • Phone: 516-783-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011369-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: