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Dr. Jack Facciolo, DO
Specialist in Rio Grande, New Jersey
NPI 1558330076

Jack Facciolo is a Specialist based in Rio Grande, NJ. Jack Facciolo practices in Rio Grande, NJ and has the professional credentials of DO. The NPI Number for Jack Facciolo is 1558330076 and holds a License No. MB039210 (New Jersey).

The current practice location address for Jack Facciolo is 1 Secluded Ln, Rio Grande, NJ and can be reached out via phone at 609-368-1952.

Location: 1 Secluded Ln, Rio Grande, NJ, 08242-1546
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1558330076
Provider Name
Jack Facciolo
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
1 Secluded Ln, Rio Grande, NJ, 08242-1546
Phone Number
609-368-1952
Fax Number
Provider Enumeration Date
03/16/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1213261003 01 NJ CIGNA PPO NUMBER
2345005 05 NJ
CMS005 01 NJ OXFORD PROVIDER NUMBER
1074056 01 NJ HORIZON NJ HEALTH NUMBER
825040 01 NJ CIGNA HMO NUMBER
0090462000 01 NJ INDP BCBS PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
1 Secluded Ln
City
Rio Grande
State
New Jersey
Zip
08242-1546
Phone Number
609-368-1952
Fax Number
person
Provider Business Mailing Address Details
Address
1 Secluded Ln
City
Rio Grande
State
New Jersey
Zip
08242-1546
Phone Number
609-368-1952
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
MB039210 (New Jersey)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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