Provider Demographics
NPI:1285740472
Name:SCICCHITANO, CAROL ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:SCICCHITANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MADISON ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3248
Mailing Address - Country:US
Mailing Address - Phone:516-997-4880
Mailing Address - Fax:516-997-4881
Practice Address - Street 1:309 MADISON ST STE 9
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3248
Practice Address - Country:US
Practice Address - Phone:516-997-4880
Practice Address - Fax:516-997-4881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4754111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX40091Medicare ID - Type Unspecified