MEDICARE: MARISA GARGIULO CIAMPI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	831179373	NY

General Provider Information

NPI Number	:	1003286147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA GARGIULO CIAMPI

Provider Business Mailing Address
First Line	:	370 LITTLE CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1632 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3504
Country	:	US
Telephone Number	:	718-448-9650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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