Healthcare Provider Details

I. General information

NPI: 1881790731
Provider Name (Legal Business Name): MARCO ANTHONY PICARIELLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ROUTE 25A
SAINT JAMES NY
11780-1704
US

IV. Provider business mailing address

409 ROUTE 25A
SAINT JAMES NY
11780-1704
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-7700
  • Fax:
Mailing address:
  • Phone: 631-862-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: