Dr Salvatore Licciardone, DO is a
Family Medicine physician based in Park Ridge, New Jersey. Dr Salvatore Licciardone is licensed to practice in New Jersey (license number 25MB02322300) and his current practice location is 74 Pascack Rd, Park Ridge, New Jersey. He can be reached at his office (for appointments etc.) via phone at
(201) 391-4166.
NPI number for Dr Salvatore Licciardone is 1205889045 and his current mailing address is 1319 Wickford Ln, Lanoka Harbor, New Jersey. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1205889045.
Physician's Profile
| Full Name | Dr Salvatore Licciardone |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 74 Pascack Rd, Park Ridge, New Jersey |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1205889045
- Provider Enumeration Date: 05/19/2006
- Last Update Date: 10/14/2010
Medical Identifiers
Medical identifiers for Dr Salvatore Licciardone such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1205889045 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 25MB02322300 (New Jersey) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Salvatore Licciardone is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Salvatore Licciardone, DO
1319 Wickford Ln,
Lanoka Harbor, NJ 08734-2912
Ph: (609) 242-0073 | Dr Salvatore Licciardone, DO
74 Pascack Rd,
Park Ridge, NJ 07656-1935
Ph: (201) 391-4166 |
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