Individual
PAUL CICERO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, CES
Contact information
Practice address
264 BRIDGEPORT AVE, MEDFORD, NY 11763-4019
(516) 456-1693
Mailing address
264 BRIDGEPORT AVNEUE, MEDFORD, NY 11763
(516) 456-1693
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002205
NY
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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