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General NPI Number Information
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NPI Number | 1972654424
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Entity Type | Individual
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Provider Name | JOHN GREGORY CISCO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 25 ORCHARD ST
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City | DENVILLE
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State | NJ
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Zip | 07834-2173
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Country | US
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Telephone | 973-586-3513
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Fax | 973-586-8686
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Provider Business Mailing Address
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Address Line | 50 W SHORE RD
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City | DENVILLE
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State | NJ
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Zip | 07834-1520
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Country | US
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Telephone | 973-627-0348
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Fax | 973-586-8686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2526
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License Number State | NJ
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