Provider Demographics
NPI:1174667315
Name:CECILIONE, EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CECILIONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5066
Mailing Address - Country:US
Mailing Address - Phone:518-869-6220
Mailing Address - Fax:518-869-6465
Practice Address - Street 1:1971 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5066
Practice Address - Country:US
Practice Address - Phone:518-869-6220
Practice Address - Fax:518-869-6465
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025396225100000X
NY025396-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00318814Medicaid
NY330250Medicare ID - Type Unspecified