Provider Demographics
NPI:1275156358
Name:CICCONE, STEVEN THOMAS (RT(R)(CT)(MR)(VI))
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THOMAS
Last Name:CICCONE
Suffix:
Gender:M
Credentials:RT(R)(CT)(MR)(VI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4621
Mailing Address - Country:US
Mailing Address - Phone:347-220-2685
Mailing Address - Fax:
Practice Address - Street 1:520 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:212-746-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5702232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology