PHILLIP MARTIN CICCO (NPI# 1679987143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679987143 |
| Entity Type | Individual |
| Full Name | PHILLIP MARTIN CICCO |
| Credential | N.P. |
| Practice Address |
736 Irving Ave Syracuse NY 13210-1687 |
| Mailing Address |
5046 Revolutionary Path Liverpool NY 13088 |
| Practice Telephone | 3154707111 |
| Mailing Telephone | 5704987688 |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 338748 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
736 IRVING AVE |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13210-1687 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760485056 | Jesse S Williams | Internal Medicine | 736 Irving Ave, Syracuse, NY 13210-1687 | 2005-05-31 |
| 1417555079 | Drake Kingdon Burgess | Physician Assistant | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-10-15 |
| 1265030753 | Mallory Conner | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-10-15 |
| 1073129029 | Kaitlyn Hazelmyer | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-09-16 |
| 1518571876 | Jessica Garza | Pharmacist | 736 Irving Ave, Syracuse, NY 13210-1690 | 2020-09-03 |
| 1114542511 | Heather N Bedard | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-06-11 |
| 1457975567 | Clare Murphy | Speech-Language Pathologist | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-06-04 |
| 1609498062 | Christopher James Limoncelli | Physical Therapist | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-05-08 |
| 1265060016 | Amanda Lynn Webb | Physician Assistant | 736 Irving Ave, Syracuse, NY 13210-1690 | 2020-03-28 |
| 1760013312 | Rebecca Lea Wells-stowe | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1690 | 2020-02-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558973586 | Maizie Marie Shaw | Social Worker | 660 Madison Street, Syracuse, NY 13210 | 2020-08-20 |
| 1427666916 | Christine Marie Welker | Registered Nurse | 735 Irving Avenue, Syracuse, NY 13210 | 2020-07-21 |
| 1386263994 | Ashwini Krishna Ashwath | Student in an Organized Health Care Education/Training Program | 750 E. Adams Street, Syracuse, Ny 13210, Syracuse, NY 13210 | 2020-04-14 |
| 1073142329 | Kamala Ojha | Student in an Organized Health Care Education/Training Program | 750-east Adam's Street, Syracuse, NY 13210 | 2020-04-07 |
| 1003442369 | Brittany Nicole Lippert | Counselor | 615 Madison St, Syracuse, NY 13210 | 2020-03-19 |
| 1902430499 | Dkt Physician Pllc | Internal Medicine | 475 Irving Ave, Suite 410, Syracuse, NY 13210 | 2020-02-24 |
| 1376194720 | Sarah Van Eenenaam | Physician Assistant | Adult Cardiac Surgery, 750 East Adams St, Syracuse, NY 13210 | 2019-09-26 |
| 1265099022 | Michelle Gallagher | Psychologist | Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210 | 2019-05-28 |
| 1639659428 | Francesca Wanda Cotrupe | Physical Medicine & Rehabilitation | Upstate Medical University Hospital, 750 E Adams Street, Syracuse, NY 13210 | 2018-08-21 |
| 1700370327 | Dallin Lindahl | Physical Medicine & Rehabilitation | 750 E Adams St # Jh308, Syracuse, NY 13210 | 2018-06-18 |
| Find all providers in zip 13210 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639730690 | Michelle L Lane | Nurse Practitioner | 301 Prospect Ave Fl 6, Syracuse, NY 13203-1807 | 2019-06-21 |
| 1942754015 | Shelly Lynn Peters | Nurse Practitioner | 329 N. Salina Street, Helio Health, Syracuse, NY 13203 | 2016-08-06 |
| 1205241411 | Erin M. Kreifels | Nurse Practitioner | 277 E 17th St, Syracuse, NE 68446-5000 | 2014-06-25 |
| 1174675995 | Michelle Anne Dart | Nurse Practitioner | 3229 E. Genesee St., Syracuse, NY 13214 | 2007-01-18 |
| 1750470738 | Anna Marie Santoro | Nurse Practitioner | 800 Irving Ave Rm A202, Syracuse, NY 13210-2716 | 2006-10-11 |
| 1578582128 | Sean M Murphy | Nurse Practitioner | 144 Century Dr, Syracuse, NY 13209-2204 | 2006-07-18 |
| 1356304638 | Dana L Karash | Nurse Practitioner | 1120 E Genesee St, Syracuse, NY 13210-1912 | 2006-04-08 |
| 1679547392 | Jeanne E Pietrzak | Nurse Practitioner | 739 Irving Ave Ste 500, Syracuse, NY 13210-1664 | 2006-02-17 |
| 1073129029 | Kaitlyn Hazelmyer | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-09-16 |
| 1689299505 | Kimberly Ann Cerasani | Nurse Practitioner | 90 Presidential Plz, Syracuse, NY 13202-2240 | 2020-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.