Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MA0056501 | NJ |
NPI | 1003916297 |
---|---|
Provider Name | Dr. Gerald F Ciciola JR. |
First Address | New York, NY 10087-2581 |
Second Address | West Orange, NJ 07052-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F83980 | (02) | NJ |