Basic Information
| Provider Information | |||||||||
| NPI: | 1811038920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIORCIARI | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 CROYDON AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117791927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316985201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | NY | X | Agencies | Local Education Agency (LEA) | 251C00000X | NY | X | Agencies | Day Training, Developmentally Disabled Services |
ID Information
| ID | Type | State | Issuer | Description | 1978 | 01 | NY | SPECIAL EDUCATOR | OTHER |