MEDICARE: BRITTANI LEIGH BICKEL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	012030	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083808851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANI LEIGH BICKEL PA

Provider Business Mailing Address
First Line	:	77 W BARNEY ST
Second Line	:
City	:	GOUVERNEUR
State	:	NY
Zip	:	13642-1040
Country	:	US
Telephone Number	:	315-287-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 COUNTY ROUTE 17
Second Line	:
City	:	DEKALB JUNCTION
State	:	NY
Zip	:	13630
Country	:	US
Telephone Number	:	315-347-3830
Fax Number	:	315-347-3840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	06/06/2019

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