Healthcare Provider Details

I. General information

NPI: 1871779579
Provider Name (Legal Business Name): GERARD R CICALESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WASHINGTON AVE
BELLEVILLE NJ
07109-5218
US

IV. Provider business mailing address

330 WASHINGTON AVE
BELLEVILLE NJ
07109-5218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA05656100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA05656100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: