Healthcare Provider Details

I. General information

NPI: 1528209855
Provider Name (Legal Business Name): MIDDLESEX MEDICAL & REHABILITATION GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LIVINGSTON AVE
NEW BRUNSWICK NJ
08901-2933
US

IV. Provider business mailing address

207 LIVINGSTON AVE
NEW BRUNSWICK NJ
08901-2933
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-2060
  • Fax: 973-751-3334
Mailing address:
  • Phone: 973-751-2060
  • Fax: 973-751-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB057523
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTONIO CICCONE
Title or Position: OWNER
Credential: D.O.
Phone: 973-751-2060