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General NPI Number Information
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NPI Number | 1538325220
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL PRACTICE, PC
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 413 KING GEORGE RD STE 205
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2817
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Country | US
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Telephone | 973-751-2060
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Fax | 973-751-2291
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | ROSELAND
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State | NJ
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Zip | 07068-0599
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Country | US
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Telephone | 973-493-3152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO CICCONE
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Credential | DO
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Telephone | 973-751-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB05723
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License Number State | NJ
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