Healthcare Provider Details

I. General information

NPI: 1467410373
Provider Name (Legal Business Name): GERARD T CICALESE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WASHINGTON AVE
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

330 WASHINGTON AVE
BELLEVILLE NJ
07109
US

V. Phone/Fax

Practice location:
  • Phone: 943-751-4300
  • Fax: 973-751-7577
Mailing address:
  • Phone: 943-751-4300
  • Fax: 973-751-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA56561
License Number StateNJ

VIII. Authorized Official

Name: GERARD ROBERT CICAIESE
Title or Position: DOCTOR
Credential: MD
Phone: 973-751-4300