Organization
SILVER LAKE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO CICCONE DO (PRESIDENT)
(973) 751-2060
Entity
Organization
Contact information
Practice address
36 NEWARK AVENUE, SUITE 324, BELLEVILLE, NJ 07109
(973) 751-2060
(973) 751-3334
Mailing address
36 NEWARK AVENUE, SUITE 324, BELLEVILLE, NJ 07109
(973) 751-2060
(973) 751-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB57523
NJ
Other
Enumeration date
07/02/2007
Last updated
06/16/2008
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