1356360564 NPI number — EDWARD J.P. CIECKO, DO, PC

Table of content: (NPI 1356360564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356360564 NPI number — EDWARD J.P. CIECKO, DO, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J.P. CIECKO, DO, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356360564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BRIGGS RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-231-4774
Provider Business Mailing Address Fax Number:
856-231-9699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12301 MEDFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19154-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-7666
Provider Business Practice Location Address Fax Number:
215-632-8116
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIECKO
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J.P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-632-7666

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com