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Individual

DR. GERALD VINCENT CICCARELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
2098 WANTAGH AVE, WANTAGH, NY 11793-3914
(516) 781-5225
(516) 781-9359
Mailing address
2098 WANTAGH AVE, WANTAGH, NY 11793-3914
(516) 781-5225
(516) 781-9359

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
003224
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00685516
NY
Enumeration date
07/13/2005
Last updated
12/10/2007
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