Provider Demographics
NPI:1134384266
Name:CIANCIOTTA, SAVERIO (PA)
Entity type:Individual
Prefix:MR
First Name:SAVERIO
Middle Name:
Last Name:CIANCIOTTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1612
Mailing Address - Country:US
Mailing Address - Phone:516-663-2224
Mailing Address - Fax:516-663-8166
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1612
Practice Address - Country:US
Practice Address - Phone:516-663-2224
Practice Address - Fax:516-663-8166
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1134384266Medicare NSC