Provider Demographics
NPI:1265513204
Name:CICORIA, MARIA ROSARIA (OTRCHT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROSARIA
Last Name:CICORIA
Suffix:
Gender:F
Credentials:OTRCHT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ROSARIA
Other - Last Name:MARTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:
Practice Address - Street 1:550 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1634
Practice Address - Country:US
Practice Address - Phone:914-777-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004783225X00000X
CT002954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7769245OtherAETNA
P2485155OtherOXFORD
Q53831Medicare ID - Type Unspecified