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NPI Code Detail

MEDICARE: MR. GEORGE CIRESI III D.P.T.

MEDICARE: MR. GEORGE CIRESI III D.P.T.
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
1174400000XSpecialist025766-1NY

General Provider Information

NPI Number : 1366484651
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE CIRESI III D.P.T.
Provider Business Mailing Address
First Line : 191 PATCHOGUE YAPHANK RD
Second Line :
City : EAST PATCHOGUE
State : NY
Zip : 11772-4899
Country : US
Telephone Number : 631-775-0971
Fax Number : 631-475-0975
Provider Business Practice Location Address
First Line : 191 PATCHOGUE YAPHANK RD
Second Line :
City : EAST PATCHOGUE
State : NY
Zip : 11772-4899
Country : US
Telephone Number : 631-775-0971
Fax Number : 631-475-0975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 11/27/2019

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