Provider Demographics
NPI:1093834939
Name:CIRIGLIANO, ROCCO J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:J
Last Name:CIRIGLIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DOSORIS WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2618
Mailing Address - Country:US
Mailing Address - Phone:516-671-0873
Mailing Address - Fax:
Practice Address - Street 1:24 DOSORIS WAY
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2618
Practice Address - Country:US
Practice Address - Phone:516-671-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005-209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV53341Medicare ID - Type UnspecifiedPSYCHOLOGIST