Healthcare Provider Details

I. General information

NPI: 1114010626
Provider Name (Legal Business Name): MICHAEL PIKUS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 NASSAU AVE
MANHASSET NY
11030
US

IV. Provider business mailing address

152 NASSAU AVE
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 516-708-1981
  • Fax: 516-708-1983
Mailing address:
  • Phone: 516-708-1981
  • Fax: 516-708-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number048910
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: