DONALD S. CICCONE


Address: 30 Bergen St, Admc 12 1205, Newark, NJ 07107-3000
Phone: 9739720037

DONALD S. CICCONE (NPI# 1588714810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1588714810
Entity Type Individual
Full Name DONALD S. CICCONE
Credential PHD
Practice Address 30 Bergen St
Admc 12 1205
Newark
NJ 07107-3000
Practice Telephone 9739720037
Practice Fax Number 9739729355
Mailing Telephone 9739720037
Mailing Fax Number 9739729355
Enumeration Date 2007-01-11
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC0700X Psychologist
Specialization: Clinical
35SI00176400 NJ Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
NJ 5407508 05

Office Location

Street Address 30 BERGEN ST
ADMC 12 1205
City NEWARK
State NJ
Zip Code 07107-3000

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1235119686 Susan V Garstang Physical Medicine & Rehabilitation 30 Bergen St, Admc 101, Newark, NJ 07107-3000 2006-01-20
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1346694577 Helena Gvili Student in an Organized Health Care Education/Training Program 30 Bergen St, Admc11 Rm 1110, Newark, NJ 07107-3000 2016-04-13
1124413265 Tiffany Chan Student in an Organized Health Care Education/Training Program 30 Bergen St, Emergency Medicine, Admc-11, Rm 1110, Newark, NJ 07107-3000 2015-04-06
1801152939 Subhanir Sunil Chitnis Emergency Medicine 30 Bergen St, Admc 11, Room 1110, Newark, NJ 07107-3000 2012-04-03
1659647873 Chidinma Dawn Kabba Emergency Medicine 30 Bergen St, Admc 11 Room 1110, Newark, NJ 07107-3000 2012-04-02
1407122328 Joseph Alan Rogers Student in an Organized Health Care Education/Training Program 30 Bergen St, Admc 11 Room 1110, Newark, NJ 07107-3000 2012-03-26
1477842631 Suzanne A Katsetos Emergency Medicine 30 Bergen St, Admc 11, Rm 1110, Newark, NJ 07107-3000 2011-03-28
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Taxonomy Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

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Competitor

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City NEWARK
Zip Code 07107

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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