Healthcare Provider Details

I. General information

NPI: 1821177825
Provider Name (Legal Business Name): SERGEY K KULIKOV D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FRANKLIN BLVD SUITE 102
LONG BEACH NY
11561-4501
US

IV. Provider business mailing address

2152 MEROKEE DR
MERRICK NY
11566-3603
US

V. Phone/Fax

Practice location:
  • Phone: 516-889-0100
  • Fax: 516-897-2425
Mailing address:
  • Phone: 516-379-8006
  • Fax: 516-379-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: