MEDICARE: MRS. MARY ANNE CICARELLI M.S,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
1	225100000X	Physical Therapist	024708-1	NY

General Provider Information

NPI Number	:	1720231152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANNE CICARELLI M.S,P.T.

Provider Business Mailing Address
First Line	:	8 COBB CT
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2947
Country	:	US
Telephone Number	:	631-425-4921
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 COBB CT
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2947
Country	:	US
Telephone Number	:	631-425-4921
Fax Number	:

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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