Provider Demographics
NPI:1063709681
Name:CIAVATTA, CELESTE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:CIAVATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CARR AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1940 COMMERCE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4428
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00590000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist