Provider Demographics
NPI:1396728069
Name:CIOCCO, ROBERT W (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:CIOCCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1131
Mailing Address - Country:US
Mailing Address - Phone:973-661-1290
Mailing Address - Fax:973-661-1291
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1131
Practice Address - Country:US
Practice Address - Phone:973-661-1290
Practice Address - Fax:973-661-1291
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00181800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3376907Medicaid
NJ532205Medicare ID - Type Unspecified
T89835Medicare UPIN