MEDICARE: FREDERICK LICCIARDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician	182351	NY

General Provider Information

NPI Number	:	1447207527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK LICCIARDI MD

Provider Business Mailing Address
First Line	:	700 HICKSVILLE RD STE 205
Second Line	:
City	:	BETHPAGE
State	:	NY
Zip	:	11714-3472
Country	:	US
Telephone Number	:	267-339-7843
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 E 53RD ST FL 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4602
Country	:	US
Telephone Number	:	212-263-7754
Fax Number	:	212-263-8827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	03/25/2025

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