Autumn Ridge Primary Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

AUTUMN RIDGE PRIMARY CARE LLC

Practice address

3350 Hwy 138 Ste 217
Wall Township, NJ 07719-9694

Phone

(732) 974-1980

Fax

(732) 974-8020

NPI assigned

Mar 3, 2020

Organization subpart

No

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

Authorized official

Name

Janice Siciliano, DO

Title

President

Phone

(732) 974-1980

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1306471065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 HWY 138 STE 217",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199694",
            "telephone_number": "732-974-1980",
            "fax_number": "732-974-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 HWY 138 STE 217",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199694",
            "telephone_number": "732-974-1980",
            "fax_number": "732-974-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN RIDGE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "SICILIANO",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-974-1980",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amara Dental of Wall, P.a.
• Lorraine Antine, LORRAINE ANTINE LCSW
• Charmaine Arenas, NP-C, PMHNP-BC
• Lauren Catherine-Paige Ashenfelder
• Atlantic Gynecologic on
• Lauren Bacharach, OD
• Cynthia Hope Barabas, M.D.
• Ronald Barabas, M.D.
• Jamie Barry
• John T Barry, DPT

• Internal Medicine Physician in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.