Healthcare Provider Details

I. General information

NPI: 1588648083
Provider Name (Legal Business Name): NOEL S CIOCON D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 HIGHWAY 18 STE 106
EAST BRUNSWICK NJ
08816-4910
US

IV. Provider business mailing address

1262 WASHINGTON VALLEY RD
BRIDGEWATER NJ
08807-1429
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0090
  • Fax: 732-254-2292
Mailing address:
  • Phone: 732-887-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00787100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: