Provider Demographics
NPI:1467410373
Name:GERARD T CICALESE MD PA
Entity Type:Organization
Organization Name:GERARD T CICALESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CICAIESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-4300
Mailing Address - Street 1:330 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:943-751-4300
Mailing Address - Fax:973-751-7577
Practice Address - Street 1:330 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:943-751-4300
Practice Address - Fax:973-751-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5995302Medicaid
NJ510657Medicare PIN
F71928Medicare UPIN