Healthcare Provider Details

I. General information

NPI: 1003916297
Provider Name (Legal Business Name): GERALD F CICIOLA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 NORTHFIELD AVE
WEST ORANGE NJ
07052-4723
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-4505
  • Fax: 973-736-9066
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA0056501
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: