Facciolo, Jack

Facciolo, Jack is an individual health care provider with primary practice located at 1 Secluded Ln , Rio Grande NJ 08242-1546. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Facciolo, Jack can be contacted via phone (609) 368-1952.

Contact Information

Primary practice address
1 Secluded Ln Rio Grande NJ 08242-1546
Phone: (609) 368-1952
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MB039210 New Jersey

Profile Details

NPI number 1558330076
LBN Legal business name Facciolo, Jack
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2006
Last updated Dec 1st, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558330076 NPPES
New Jersey Other 1213261003 CIGNA PPO NUMBER
New Jersey MEDICAID 2345005 CIGNA PPO NUMBER
New Jersey Other CMS005 CIGNA PPO NUMBER
New Jersey Other 1074056 CIGNA PPO NUMBER
New Jersey Other 825040 CIGNA PPO NUMBER
New Jersey Other 0090462000 CIGNA PPO NUMBER

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