Healthcare Provider Details

I. General information

NPI: 1003266818
Provider Name (Legal Business Name): GIOVANNA CICCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PARROTT RD
WEST NYACK NY
10994-1025
US

IV. Provider business mailing address

2937 BAISLEY AVE GROUND FLOOR
BRONX NY
10461-9800
US

V. Phone/Fax

Practice location:
  • Phone: 917-574-6304
  • Fax:
Mailing address:
  • Phone: 917-574-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0205061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: