Provider Demographics
NPI:1174947659
Name:RONALD P. CICCONE, M.D. P.C.
Entity type:Organization
Organization Name:RONALD P. CICCONE, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1856-869-3126
Mailing Address - Street 1:900 HADDON AVE
Mailing Address - Street 2:SUITE 136
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2101
Mailing Address - Country:US
Mailing Address - Phone:856-869-3126
Mailing Address - Fax:856-833-2050
Practice Address - Street 1:900 HADDON AVE
Practice Address - Street 2:SUITE 136
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2101
Practice Address - Country:US
Practice Address - Phone:856-869-3126
Practice Address - Fax:856-833-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1376578237OtherINDIVIDUAL NPI
NJ073809R73Medicare PIN
NJ1376578237OtherINDIVIDUAL NPI