Provider Demographics
NPI:1871612606
Name:CICCONE, MARILYN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:CICCONE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1329
Mailing Address - Country:US
Mailing Address - Phone:516-483-3037
Mailing Address - Fax:
Practice Address - Street 1:288 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2039
Practice Address - Country:US
Practice Address - Phone:516-505-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010863-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist