# THE GOUT INSTITUTE OF AMERICA AT BELLEVILLE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477046092
- **Authorized official:** ANTONIO CICCONE DO (MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 751-2060

## Contact information

- **Practice address:** 727 JORALEMON ST, BELLEVILLE, NJ 07109-1455
- **Practice address phone:** (973) 751-2060
- **Practice address fax:** (973) 751-2291
- **Mailing address:** 727 JORALEMON ST, BELLEVILLE, NJ 07109-1455
- **Mailing address phone:** (973) 751-2060
- **Mailing address fax:** (973) 751-2291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | 25MB05752300 | NJ | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/08/2018
- **Last updated:** 06/08/2018