Provider Demographics
NPI:1114978939
Name:PARTNERS IN FREEDOM LLC
Entity Type:Organization
Organization Name:PARTNERS IN FREEDOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL DELEGATE/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SICILIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-974-1980
Mailing Address - Street 1:3350 HWY 138 STE 217
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9694
Mailing Address - Country:US
Mailing Address - Phone:732-974-1980
Mailing Address - Fax:732-681-0835
Practice Address - Street 1:3350 HWY 138 STE 217
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9694
Practice Address - Country:US
Practice Address - Phone:732-974-1980
Practice Address - Fax:732-681-0835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARTNERS IN FREEDOM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5599107OtherGHI
NJ60004140OtherHORIZON NJ HEALTH
NJ2296455001OtherAMERIHEALTH SEA GIRT LOCA
NJ0034835Medicaid
NJ2296455002OtherAMERIHEALTH HOWELL LOCATI
NJDB7403OtherRAILROAD MEDICARE
NJ60004140OtherHORIZON NJ HEALTH