Organization
NJ PAIN REHABILITATION GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO CICCONE DO (OWNER)
(973) 751-2060
Entity
Organization
Contact information
Practice address
631 BROADWAY, FIRST FLOOR, BAYONNE, NJ 07002
(973) 751-2060
Mailing address
885 BROADWAY PMB168, PMB168, BAYONNE, NJ 07002
(973) 751-2060
(973) 751-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB057523
NJ
Other
Enumeration date
04/09/2008
Last updated
10/02/2008
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