Provider Demographics
NPI:1760458699
Name:CALICCHIO, JOHN J (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CALICCHIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:57 ROUTE 46
Practice Address - Street 2:SUITE 100
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-598-7980
Practice Address - Fax:908-852-4185
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB070356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053830Medicaid
NJ0053830Medicaid
NJH71241Medicare UPIN