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Organization
THE GOUT INSTITUTE OF AMERICA AT BELLEVILLE, PC
Active
Organization
THE GOUT INSTITUTE OF AMERICA AT BELLEVILLE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO CICCONE DO (MEDICAL DIRECTOR)
(973) 751-2060
Entity
Organization
Contact information
Practice address
727 JORALEMON ST, BELLEVILLE, NJ 07109-1455
(973) 751-2060
(973) 751-2291
Mailing address
727 JORALEMON ST, BELLEVILLE, NJ 07109-1455
(973) 751-2060
(973) 751-2291
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
25MB05752300
NJ
261QM2500X
Medical Specialty Clinic/Center
—
NULL
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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