Provider Demographics
NPI:1528209855
Name:MIDDLESEX MEDICAL & REHABILITATION GROUP, PC
Entity Type:Organization
Organization Name:MIDDLESEX MEDICAL & REHABILITATION GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-751-2060
Mailing Address - Street 1:207 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2933
Mailing Address - Country:US
Mailing Address - Phone:973-751-2060
Mailing Address - Fax:973-751-3334
Practice Address - Street 1:207 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2933
Practice Address - Country:US
Practice Address - Phone:973-751-2060
Practice Address - Fax:973-751-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB057523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty