Basic Information
| Provider Information | |||||||||
| NPI: | 1174947659 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RONALD P. CICCONE, M.D. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 HADDON AVE | ||||||||
| Address2: | SUITE 136 | ||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568693126 | ||||||||
| FaxNumber: | 8568332050 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HADDON AVE | ||||||||
| Address2: | SUITE 136 | ||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568693126 | ||||||||
| FaxNumber: | 8568332050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2014 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | CICCONE | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 18568693126 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1376578237 | 01 | NJ | INDIVIDUAL NPI | OTHER |