Silver Lake Medical, PC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

MB057523 Issued in NJ

Legal business name

SILVER LAKE MEDICAL, PC

Practice address

50 Newark Ave
Suite 205 - 207
Belleville, NJ 07109-1185

Phone

(973) 751-2060

NPI assigned

Sep 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Antonio Ciccone, DO

Title

President

Phone

(973) 751-2060

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268352000000",
    "number": "1275728842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 NEWARK AVE",
            "address_2": "SUITE 205 - 207",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091185",
            "telephone_number": "973-751-2060",
            "fax_number": "973-751-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 NEWARK AVE",
            "address_2": "SUITE 205 - 207",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091185",
            "telephone_number": "973-751-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER LAKE MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2010-03-12",
        "status": "A",
        "authorized_official_last_name": "CICCONE",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-751-2060",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NJ",
            "license": "MB057523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Murtaza Siddique, PA-C
• Michael Sideris
• Signature Wellness Center Belleville LLC
• Andrey Silkov, MD
• Silver Lake Medical PC
• Silver Lake Medical, PC
• Silver Lake Physical Therapy LLC
• Rahniel Angelo Simon
• Pratap C Singhal, M.D.
• Tatyiana Singletary

• Adult Medicine Physician in Belleville, NJ
• Providers in Belleville, NJ by specialty
• Adult Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.