Healthcare Provider Details

I. General information

NPI: 1700733565
Provider Name (Legal Business Name): CIOGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERVIEW PLZ
RED BANK NJ
07701-1864
US

IV. Provider business mailing address

130 NEW MONMOUTH RD
MIDDLETOWN NJ
07748-2231
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-2700
  • Fax:
Mailing address:
  • Phone: 917-569-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JOSE GABRIEL ANDRADE
Title or Position: OWNER
Credential: MD
Phone: 917-569-4435