Provider Demographics
NPI:1689612129
Name:SICILIANO, JANICE
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:SICILIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HIGHWAY 35 STE 324
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1011
Mailing Address - Country:US
Mailing Address - Phone:732-974-8005
Mailing Address - Fax:732-974-8020
Practice Address - Street 1:2130 HIGHWAY 35 STE 324
Practice Address - Street 2:BUILDING C
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1011
Practice Address - Country:US
Practice Address - Phone:732-974-8005
Practice Address - Fax:732-974-8020
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ614303SSXMedicare PIN