Provider Demographics
NPI:1245335033
Name:STORETVEIT, CYNTHIA (NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:STORETVEIT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BELLE TERRE RD
Mailing Address - Street 2:PMTR DEPT 1ST FLOOR, ADVANCED REHABILITATION MED.
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-474-6879
Mailing Address - Fax:631-474-6448
Practice Address - Street 1:170 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9091
Practice Address - Country:US
Practice Address - Phone:631-331-4377
Practice Address - Fax:631-331-4459
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY336755363L00000X
NYF381111363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348483Medicaid
1U2752Medicare ID - Type Unspecified
NY02348483Medicaid