Provider Demographics
NPI:1215246483
Name:PALIOTTA, CANICE
Entity type:Individual
Prefix:MS
First Name:CANICE
Middle Name:
Last Name:PALIOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:PALIOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:3731 STATE HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3304
Mailing Address - Country:US
Mailing Address - Phone:607-843-9337
Mailing Address - Fax:
Practice Address - Street 1:3731 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-3304
Practice Address - Country:US
Practice Address - Phone:607-843-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005150-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005150-1OtherMASSAGE THERAPIST LICENSE
NYZFM 1418P8933OtherMEDICARE BLUE PPO