=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467410373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERARD T CICALESE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 09/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 WASHINGTON AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 943-751-4300
-----------------------------------------------------
Fax | 973-751-7577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 WASHINGTON AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 943-751-4300
-----------------------------------------------------
Fax | 973-751-7577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | GERARD ROBERT CICAIESE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-751-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MA56561
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------