Provider Demographics
NPI:1780281964
Name:CORMICAN, CIARAN PATRICK (MSED)
Entity type:Individual
Prefix:MR
First Name:CIARAN
Middle Name:PATRICK
Last Name:CORMICAN
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROGERS PL
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1727
Mailing Address - Country:US
Mailing Address - Phone:646-593-2011
Mailing Address - Fax:
Practice Address - Street 1:33 ROGERS PL
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1727
Practice Address - Country:US
Practice Address - Phone:646-593-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist