Provider Demographics
NPI:1114184751
Name:CICCONE, MARTHA STELLA (RPH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:STELLA
Last Name:CICCONE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:STELLA
Other - Last Name:VOLPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:300 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3142
Mailing Address - Country:US
Mailing Address - Phone:212-281-3480
Mailing Address - Fax:
Practice Address - Street 1:300 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3142
Practice Address - Country:US
Practice Address - Phone:212-281-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036446-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist