Provider Demographics
NPI:1184970329
Name:TICZON, ROBERT PARCON
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PARCON
Last Name:TICZON
Suffix:
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 1:601 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2527
Mailing Address - Country:US
Mailing Address - Phone:908-425-1108
Mailing Address - Fax:
Practice Address - Street 1:601 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2527
Practice Address - Country:US
Practice Address - Phone:908-425-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist