Provider Demographics
NPI:1588648083
Name:CIOCON, NOEL S (DPT)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:S
Last Name:CIOCON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1429
Mailing Address - Country:US
Mailing Address - Phone:732-887-8078
Mailing Address - Fax:
Practice Address - Street 1:758 HIGHWAY 18
Practice Address - Street 2:STE 106
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4910
Practice Address - Country:US
Practice Address - Phone:732-254-0090
Practice Address - Fax:732-254-2292
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00787100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q14064Medicare UPIN
NJ078372SQJMedicare ID - Type Unspecified