Healthcare Provider Details

I. General information

NPI: 1851614200
Provider Name (Legal Business Name): MARTINA LIRIOS-SICILIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 PAULDING AVE
BRONX NY
10462-2100
US

IV. Provider business mailing address

2174 PAULDING AVE
BRONX NY
10462-2100
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-1652
  • Fax: 718-918-1652
Mailing address:
  • Phone: 718-918-1652
  • Fax: 718-918-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number152323
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number152323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: