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General NPI Number Information
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NPI Number | 1992363550
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Entity Type | Individual
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Provider Name | JONATHAN JOSEPH SICILIA NP
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Gender | Male
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 4939 BRITTONFIELD PKWY STE 101
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9208
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Country | US
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Telephone | 315-463-1600
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Fax | 315-634-6793
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Provider Business Mailing Address
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Address Line | 4939 BRITTONFIELD PKWY STE 101
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9208
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Country | US
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Telephone | 315-634-6779
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Fax | 315-634-6789
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F344407
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License Number State | NY
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