Healthcare Provider Details

I. General information

NPI: 1154553568
Provider Name (Legal Business Name): JOSEPH JAMES CILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FURNACE RD
CHESTER NJ
07930-2080
US

IV. Provider business mailing address

26 FURNACE RD
CHESTER NJ
07930-2080
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-7150
  • Fax:
Mailing address:
  • Phone: 908-879-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA01756900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: