Provider Demographics
NPI:1225253222
Name:VANISKY, CECILIA (NP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:VANISKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:900 MERCHANTS CONCOURSE STE 216
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5114
Mailing Address - Country:US
Mailing Address - Phone:516-226-8373
Mailing Address - Fax:
Practice Address - Street 1:4 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3363
Practice Address - Country:US
Practice Address - Phone:631-331-0500
Practice Address - Fax:631-331-1644
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY360059363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner