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
—
—
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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