Organization
AUTUMN RIDGE PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE SICILIANO DO (PRESIDENT)
(732) 974-1980
Entity
Organization
Contact information
Practice address
3350 HWY 138 STE 217, WALL TOWNSHIP, NJ 07719-9694
(732) 974-1980
(732) 974-8020
Mailing address
3350 HWY 138 STE 217, WALL TOWNSHIP, NJ 07719-9694
(732) 974-1980
(732) 974-8020
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
08/31/2020
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