Healthcare Provider Details

I. General information

NPI: 1952043416
Provider Name (Legal Business Name): WILLIAM THOMAS DICIURCIO III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL DRIVE SUITE 162
STRATFORD NJ
08084
US

IV. Provider business mailing address

1 MEDICAL CENTER DR STE 162
STRATFORD NJ
08084-1500
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: