Individual provider Active NPI

Robert W. Ciocco, D.P.M.

  • Podiatrist
  • Nutley, NJ
National Provider Identifier
1396728069
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
25MD00181800 Issued in NJ
Practice address
25 High St
Nutley, NJ 07110-1131
Phone
(973) 661-1290
Fax
(973) 661-1291
NPI assigned
Nov 26, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 25MD00181800 NJ Primary

Addresses

Primary practice location

25 High St
Nutley, NJ 07110-1131

Mailing address

25 High St
Nutley, NJ 07110-1131
Phone (973) 661-1290

Other identifiers 1

IdentifierTypeStateIssuer
3376907MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111207000066 NJ Practitioner - Podiatry 0941475784 Reassigns benefits to 1 organization
Practice locations: Nutley, NJ

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Avenue Podiatry Associates PCGroup PAC ID 4082875919, 2 clinicians

Practice addresses (Care Compare)

25 High St
Nutley, NJ 07110-1131
Phone (973) 661-1290

264 Millburn Ave
Millburn, NJ 07041-1710
Phone (973) 376-9292

342 Central Ave
Jersey City, NJ 07307-2918
Phone (201) 653-1949

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1380
Removal or shaving of skin growth513

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25MD00181800NJMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Avenue Podiatry Associates PC Podiatrist CurrentSince Jul 17, 2013 Accepting new patients

Locations

342 Central Ave
Jersey City, NJ 07307
Phone (201) 653-1949

264 Millburn Ave
Ste 100
Millburn, NJ 07041

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1132963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319155200000",
    "number": "1396728069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HIGH ST",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071101131",
            "telephone_number": "973-661-1290",
            "fax_number": "973-661-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HIGH ST",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071101131",
            "telephone_number": "973-661-1290",
            "fax_number": "973-661-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIOCCO",
        "first_name": "ROBERT",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-26",
        "last_updated": "2011-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00181800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3376907",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

Verify at the official NPI Registry.