Provider Demographics
NPI:1366484651
Name:CIRESI, GEORGE III (DPT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CIRESI
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4899
Mailing Address - Country:US
Mailing Address - Phone:631-775-0971
Mailing Address - Fax:631-475-0975
Practice Address - Street 1:191 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4899
Practice Address - Country:US
Practice Address - Phone:631-775-0971
Practice Address - Fax:631-475-0975
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025766-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400003354Medicare PIN