Provider Demographics
NPI:1427007905
Name:CICCONE, RALPH JOHN III (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JOHN
Last Name:CICCONE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 SEAVIEW AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-980-5700
Mailing Address - Fax:718-980-5710
Practice Address - Street 1:501 SEAVIEW AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-980-5700
Practice Address - Fax:718-980-5499
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY151919207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C4192OtherTOUCHSTONE
151919C11OtherHEALTHFIRST
0641956002OtherCIGNA
0092963OtherGHI
151919OtherHIP
16D921OtherBLUE CROSS
NY01495514Medicaid
164966OtherELDERPLAN
87226OtherAETNA
OS118OtherOXFORD
OS118OtherOXFORD
0092963OtherGHI