Healthcare Provider Details

I. General information

NPI: 1679148902
Provider Name (Legal Business Name): SARAH JANE CICCARELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W GERMANTOWN PIKE
NORRISTOWN PA
19403-4250
US

IV. Provider business mailing address

26 N 6TH ST APT 474
ALLENTOWN PA
18101-1438
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-1000
  • Fax:
Mailing address:
  • Phone: 973-600-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMT222829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: