Healthcare Provider Details

I. General information

NPI: 1700052685
Provider Name (Legal Business Name): JEFFREY MICHAEL CICCONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EARLE OVINGTON BLVD STE 101
UNIONDALE NY
11553-3645
US

IV. Provider business mailing address

333 EARLE OVINGTON BLVD STE 101
UNIONDALE NY
11553-3645
US

V. Phone/Fax

Practice location:
  • Phone: 162-402-1625
  • Fax: 212-517-4481
Mailing address:
  • Phone: 516-240-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number242621
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number242621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: