Provider Demographics
NPI:1225187842
Name:SICOLA, CORINNE MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:MARIE
Last Name:SICOLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 FARMER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1537
Mailing Address - Country:US
Mailing Address - Phone:908-526-2761
Mailing Address - Fax:908-874-4531
Practice Address - Street 1:411 US HIGHWAY 206
Practice Address - Street 2:SUITE 16
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-5024
Practice Address - Country:US
Practice Address - Phone:908-874-4522
Practice Address - Fax:908-874-4531
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00926000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065683Medicare ID - Type Unspecified