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Individual

LOUIS SICILIANO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1140 ROUTE 72 W, MANAHAWKIN, NJ 08050-2412
(609) 597-6011
Mailing address
66 WEST GILBERT ST, RED BANK, NJ 07701
(732) 212-0051
(732) 212-0713

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06394800
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7106904
NJ
Enumeration date
06/20/2005
Last updated
03/28/2008
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