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General NPI Number Information
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NPI Number | 1134198724
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Entity Type | Individual
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Provider Name | MICHAEL L. LICHARDI PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1925 PACIFIC AVENUE ATLANTICARE REGIONAL MEDICAL CENTER
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401
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Country | US
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Telephone | 732-407-1939
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-577-8340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2697
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00119100
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License Number State | NJ
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