Individual
DR. MARIO MICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
913 MAIN AVE, PASSAIC, NJ 07055-8540
(973) 458-8000
(973) 458-8425
Mailing address
913 MAIN AVENUE, PASSAIC, NJ 07055
(973) 458-8000
(973) 458-8425
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA08315100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117705702
—
TX
Enumeration date
02/13/2007
Last updated
02/05/2008
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