Provider Demographics
NPI:1245236207
Name:GERACI-CIARDULLO, KIRA ANTONIA (MD)
Entity type:Individual
Prefix:DR
First Name:KIRA
Middle Name:ANTONIA
Last Name:GERACI-CIARDULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HARRISON AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3151
Mailing Address - Country:US
Mailing Address - Phone:914-777-1179
Mailing Address - Fax:914-777-1262
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:STE 304
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3151
Practice Address - Country:US
Practice Address - Phone:914-777-1179
Practice Address - Fax:914-777-1262
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146408207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16471Medicare UPIN
NY56D271Medicare PIN