Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 124343 | NY |
NPI | 1538163423 |
---|---|
Provider Name | Dr. Marc Joseph Sicklick |
First Address | Cedarhurst, NY 11516-2302 |
Second Address | Cedarhurst, NY 11516-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02200 | GHI (01) | |
08A15 | BLUECROSS (01) | |
226249 | UNITED (01) | |
922147 | HEALTHNET (01) | |
A98936 | (02) | |
GS315 | OXFORD (01) |