Healthcare Provider Details

I. General information

NPI: 1194892224
Provider Name (Legal Business Name): CYNTHIA CICHANOWICZ ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 E MAIN ST
RIVERHEAD NY
11901-1524
US

IV. Provider business mailing address

235 N BELLE MEAD RD
EAST SETAUKET NY
11733-3456
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-8827
  • Fax:
Mailing address:
  • Phone: 631-751-3000
  • Fax: 631-675-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: