Provider Demographics
NPI:1629459219
Name:DR JOHN R CICERO SURGEON PODIATRIST INC
Entity Type:Organization
Organization Name:DR JOHN R CICERO SURGEON PODIATRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-338-3933
Mailing Address - Street 1:10 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4308
Mailing Address - Country:US
Mailing Address - Phone:973-338-3933
Mailing Address - Fax:973-338-7969
Practice Address - Street 1:10 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4308
Practice Address - Country:US
Practice Address - Phone:973-338-3933
Practice Address - Fax:973-338-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00154100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty