Individual
JOHN J DECICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D P M PC
Contact information
Practice address
875 OLD COUNTRY RD, PLAINVIEW, NY 11803-4966
(516) 681-8866
(516) 681-8890
Mailing address
875 OLD COUNTRY RD, PLAINVIEW, NY 11803-4966
(516) 681-8866
(516) 681-8890
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N0030071
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00416064
—
NY
01
—
AS198
OXFORD
—
Enumeration date
02/07/2006
Last updated
12/11/2012
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