Provider Demographics
NPI:1144247222
Name:CIOLINO, JEFFREY W (OT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:CIOLINO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CHARDONNAY DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-3829
Mailing Address - Country:US
Mailing Address - Phone:631-278-0665
Mailing Address - Fax:631-422-0900
Practice Address - Street 1:3 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4642
Practice Address - Country:US
Practice Address - Phone:631-422-0900
Practice Address - Fax:631-422-0900
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ95682Medicare ID - Type Unspecified