Individual
LIDIA CICCONETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
900 FRANKLIN AVE, VALLEY STREAM, NY 11580-2145
(516) 256-6000
Mailing address
900 FRANKLIN AVE, VALLEY STREAM, NY 11580-2145
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
008924
NY
363AS0400X
Surgical Physician Assistant
PA9103231
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001320600
—
FL
01
—
008924
LICENSE
NY
01
—
PA9103231
LICENSE #
FL
Enumeration date
09/28/2006
Last updated
11/27/2012
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