Provider Demographics
NPI:1619996725
Name:CICCARELLI, JOSEPH J (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2040
Mailing Address - Country:US
Mailing Address - Phone:201-967-0075
Mailing Address - Fax:201-967-0079
Practice Address - Street 1:820 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2040
Practice Address - Country:US
Practice Address - Phone:201-967-0075
Practice Address - Fax:201-967-0079
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00241300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1086764NJMedicaid
T45150Medicare UPIN
C1450716Medicare ID - Type Unspecified