Provider Demographics
NPI:1245727437
Name:CICHOSZ, TERESA A (MSN, RN, CDE)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:CICHOSZ
Suffix:
Gender:F
Credentials:MSN, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17415 HORACE HARDING EXPY # 2F
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1527
Mailing Address - Country:US
Mailing Address - Phone:718-762-3111
Mailing Address - Fax:718-353-6315
Practice Address - Street 1:17415 HORACE HARDING EXPY # 2F
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1527
Practice Address - Country:US
Practice Address - Phone:718-762-3111
Practice Address - Fax:718-353-6315
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312042163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator