Healthcare Provider Details

I. General information

NPI: 1851342596
Provider Name (Legal Business Name): ROBERT A SICONOLFI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S MAIN ST SUITE 1
LODI NJ
07644-2240
US

IV. Provider business mailing address

180 CORABELLE AVE
LODI NJ
07644-1706
US

V. Phone/Fax

Practice location:
  • Phone: 973-472-7465
  • Fax: 973-472-7466
Mailing address:
  • Phone: 973-472-7465
  • Fax: 973-472-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00570300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: