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General NPI Number Information
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NPI Number | 1003286147
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Entity Type | Individual
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Provider Name | MARISA GARGIULO CIAMPI
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 1632 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3504
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Country | US
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Telephone | 718-448-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 370 LITTLE CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 831179373
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License Number State | NY
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