Provider Demographics
NPI:1649422684
Name:CICCONE, DOMINICK JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:JOSEPH
Last Name:CICCONE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08518-1319
Mailing Address - Country:US
Mailing Address - Phone:609-499-2200
Mailing Address - Fax:609-499-2298
Practice Address - Street 1:14 W FRONT ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08518-1319
Practice Address - Country:US
Practice Address - Phone:609-499-2200
Practice Address - Fax:609-499-2298
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management