Provider Demographics
NPI:1770643215
Name:CIRELLO, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CIRELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-239-8805
Mailing Address - Fax:973-857-3503
Practice Address - Street 1:271 GROVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1730
Practice Address - Country:US
Practice Address - Phone:973-239-8805
Practice Address - Fax:973-857-3503
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526340Medicare PIN
NJC53758Medicare UPIN