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Organization

SILVER LAKE MEDICAL, 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
PO BOX 599, ROSELAND, NJ 07068-0599
(973) 901-1515

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
208VP0000X
Pain Medicine Physician
Primary
25MB05752300
NJ

Other

Enumeration date
06/15/2018
Last updated
06/15/2018
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