Provider Demographics
NPI:1003916297
Name:CICIOLA, GERALD F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:F
Last Name:CICIOLA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:95 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4723
Practice Address - Country:US
Practice Address - Phone:973-736-4505
Practice Address - Fax:973-736-9066
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA0056501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF83980Medicare UPIN
NJ108823Medicare ID - Type Unspecified