Provider Demographics
NPI:1588679989
Name:CICHETTI, NEIL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:JOSEPH
Last Name:CICHETTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:38 HOSPITAL DR
Mailing Address - Street 2:NORTH COUNTRY ADULT MEDICINE
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1018
Mailing Address - Country:US
Mailing Address - Phone:315-764-1121
Mailing Address - Fax:315-764-1972
Practice Address - Street 1:38 HOSPITAL DR
Practice Address - Street 2:NORTH COUNTRY ADULT MEDICINE
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1018
Practice Address - Country:US
Practice Address - Phone:315-764-1121
Practice Address - Fax:315-764-1972
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY228238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02495641Medicaid
NYH95119Medicare UPIN
NYDD7195Medicare PIN