Provider Demographics
NPI:1477535375
Name:COLICCHIO, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:COLICCHIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 CORLIES AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4862
Mailing Address - Country:US
Mailing Address - Phone:732-774-8282
Mailing Address - Fax:732-774-6816
Practice Address - Street 1:1944 CORLIES AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4862
Practice Address - Country:US
Practice Address - Phone:732-774-8282
Practice Address - Fax:732-774-6816
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1521608Medicaid
NJ452390Medicare ID - Type Unspecified
NJ532538Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NJ6472605Medicare ID - Type UnspecifiedMEDICAID GROUP NUMBER
NJ1521608Medicaid