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General NPI Number Information
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NPI Number | 1053829408
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Entity Type | Individual
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Provider Name | KATHRYN CICCOLINI AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 10 E 102ND ST
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City | NEW YORK
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State | NY
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Zip | 10029-6030
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Country | US
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Telephone | 212-241-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E 42ND ST FL 10
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City | NEW YORK
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State | NY
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Zip | 10017-5626
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F431160-1
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License Number State | NY
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