Provider Demographics
NPI:1235286188
Name:LUDWIG-CILENTO, MARY BETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:LUDWIG-CILENTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1191 FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3077
Mailing Address - Country:US
Mailing Address - Phone:732-506-7888
Mailing Address - Fax:732-506-7766
Practice Address - Street 1:1191 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3077
Practice Address - Country:US
Practice Address - Phone:732-506-7888
Practice Address - Fax:732-506-7766
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB055640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF64168Medicare UPIN
NJ107013Medicare UPIN