Provider Demographics
NPI:1518360841
Name:PICCIANO, JUSTINE (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:PICCIANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE ST 71
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1560
Mailing Address - Country:US
Mailing Address - Phone:914-478-0608
Mailing Address - Fax:914-375-3402
Practice Address - Street 1:171 MADISON AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:212-213-4660
Practice Address - Fax:212-213-4661
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist