MEDICARE: EDWARD J.P. CIECKO, DO, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1356360564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD J.P. CIECKO, DO, PC

Provider Business Mailing Address
First Line	:	1001 BRIGGS RD
Second Line	:	SUITE 210
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-4100
Country	:	US
Telephone Number	:	856-231-4774
Fax Number	:	856-231-9699

Provider Business Practice Location Address
First Line	:	12301 MEDFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1924
Country	:	US
Telephone Number	:	215-632-7666
Fax Number	:	215-632-8116

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD J.P. CIECKO
Credential	:	D.O.
Telephone Number	:	215-632-7666

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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