Provider Demographics
NPI:1629570627
Name:SICOLO FITNESS INSTITUTE LLC
Entity Type:Organization
Organization Name:SICOLO FITNESS INSTITUTE LLC
Other - Org Name:SICOLO FITNESS & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SICOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-281-4373
Mailing Address - Street 1:698 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1450
Mailing Address - Country:US
Mailing Address - Phone:201-281-4373
Mailing Address - Fax:
Practice Address - Street 1:127B QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1729
Practice Address - Country:US
Practice Address - Phone:201-281-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy