Louis J Ciccolello Sr.

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

50683 Issued in NJ

Practice address

1925 Pacific Ave
Atlantic City, NJ 08401-6713

Phone

(609) 345-4000

NPI assigned

May 15, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1747267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1396536645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 DELILAH RD STE 301",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082345102",
            "telephone_number": "609-246-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 PACIFIC AVE",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "084016713",
            "telephone_number": "609-345-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "65 W Jimmie Leeds Rd",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "NJ",
            "postal_code": "082409102",
            "country_code": "US",
            "telephone_number": "609-652-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 English Creek Ave",
            "address_2": "Building 900, Suite 905",
            "address_purpose": "LOCATION",
            "city": "egg harbor twp",
            "state": "NJ",
            "postal_code": "08234",
            "country_code": "US",
            "telephone_number": "609-833-9933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CICCOLELLO",
        "first_name": "LOUIS",
        "middle_name": "J",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-15",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NJ",
            "license": "50683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Atlantic City, NJ
• Providers in Atlantic City, NJ by specialty
• Peer Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.