Provider Demographics
NPI:1356360564
Name:EDWARD J.P. CIECKO, DO, PC
Entity type:Organization
Organization Name:EDWARD J.P. CIECKO, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JP
Authorized Official - Last Name:CIECKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-632-7666
Mailing Address - Street 1:1001 BRIGGS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4100
Mailing Address - Country:US
Mailing Address - Phone:856-231-4774
Mailing Address - Fax:856-231-9699
Practice Address - Street 1:12301 MEDFORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1924
Practice Address - Country:US
Practice Address - Phone:215-632-7666
Practice Address - Fax:215-632-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081134Medicare ID - Type Unspecified