Healthcare Provider Details

I. General information

NPI: 1871672121
Provider Name (Legal Business Name): GEORGINA CID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 US HIGHWAY 9
HOWELL NJ
07731-3329
US

IV. Provider business mailing address

PO BOX 6111
FREEHOLD NJ
07728-6111
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-0165
  • Fax:
Mailing address:
  • Phone: 732-294-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA054315
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: