Healthcare Provider Details

I. General information

NPI: 1619264777
Provider Name (Legal Business Name): DEBRA CIORCIARI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date: 08/27/2014
Reactivation Date: 04/11/2016

III. Provider practice location address

157-15 19TH AVE QUEENS CENTER FOR REHABILITATION AND HEALTHCARE
WHITESTONE NY
11357
US

IV. Provider business mailing address

7517 67TH RD 1
MIDDLE VILLAGE NY
11379-2628
US

V. Phone/Fax

Practice location:
  • Phone: 718-326-1731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number303696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: