Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DI02261600 | NJ |
NPI | 1144429390 |
---|---|
Provider Name | Mr. Carmen Cicalese |
First Address | East Hanover, NJ 07936-3734 |
Second Address | Somerville, NJ 08876-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 17/07/2007 |