Organization
SILVER LAKE MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO CICCONE DO (PRESIDENT)
(973) 751-2060
Entity
Organization
Contact information
Practice address
50 NEWARK AVE, SUITE 205 - 207, BELLEVILLE, NJ 07109-1185
(973) 751-2060
Mailing address
50 NEWARK AVE, SUITE 205 - 207, BELLEVILLE, NJ 07109-1185
(973) 751-2060
(973) 751-3334
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MB057523
NJ
Other
Enumeration date
09/07/2007
Last updated
03/12/2010
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