Provider Demographics
NPI:1265848097
Name:SICILIANO, CHRISTOPHER (R N)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SICILIANO
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:CHRISTOPH
Other - Middle Name:
Other - Last Name:SICILIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:R N
Mailing Address - Street 1:198 KENTUCKY WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4653
Mailing Address - Country:US
Mailing Address - Phone:732-551-1180
Mailing Address - Fax:
Practice Address - Street 1:198 KENTUCKY WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4653
Practice Address - Country:US
Practice Address - Phone:732-551-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12665700163W00000X, 163WA0400X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical