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General NPI Number Information
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NPI Number | 1871612606
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Entity Type | Individual
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Provider Name | MARILYN CICCONE MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 288 HEMPSTEAD AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2039
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Country | US
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Telephone | 516-505-0755
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Fax |
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Provider Business Mailing Address
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Address Line | 1294 WARWICK ST
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City | UNIONDALE
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State | NY
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Zip | 11553-1329
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Country | US
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Telephone | 516-483-3037
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 010863-1
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License Number State | NY
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