Individual
PHILLIP MARTIN CICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
736 IRVING AVE, SYRACUSE, NY 13210-1687
(315) 470-7111
Mailing address
5046 REVOLUTIONARY PATH, LIVERPOOL, NY 13088
(570) 498-7688
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
338748
NY
Other
Enumeration date
06/12/2014
Last updated
07/10/2024
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