Healthcare Provider Details

I. General information

NPI: 1427007905
Provider Name (Legal Business Name): RALPH JOHN CICCONE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVENUE SUITE 102
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

501 SEAVIEW AVENUE SUITE 102
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-5700
  • Fax: 718-980-5499
Mailing address:
  • Phone: 718-980-5700
  • Fax: 718-980-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number151919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: