Provider Demographics
NPI:1992812564
Name:CICIO, GARY (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:CICIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541
Mailing Address - Country:US
Mailing Address - Phone:845-621-5006
Mailing Address - Fax:845-621-5006
Practice Address - Street 1:1049 FRANKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-861-5650
Practice Address - Fax:718-861-5654
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN003225OtherNY STATE ED DEPT
NYN003225OtherNY STATE ED DEPT
T51059Medicare UPIN
NYP3548Medicare ID - Type Unspecified