Provider Demographics
NPI:1801875828
Name:ZICCARDI, JAMES W (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:ZICCARDI
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 1:408 BETHEL RD
Mailing Address - Street 2:BLDG D
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2172
Mailing Address - Country:US
Mailing Address - Phone:609-926-9010
Mailing Address - Fax:609-926-3392
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:BLDG D
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-9010
Practice Address - Fax:609-926-3392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24147207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2108909Medicaid
C54307Medicare UPIN
110731CBOMedicare ID - Type Unspecified