Healthcare Provider Details

I. General information

NPI: 1366420598
Provider Name (Legal Business Name): ROBERT BENJAMIN SICA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 ROUTE 33, STE 202
NEPTUNE NJ
07753
US

IV. Provider business mailing address

1944 ROUTE 33, STE 202
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3441
  • Fax: 732-961-1873
Mailing address:
  • Phone: 732-988-3441
  • Fax: 732-961-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35SI00151900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: