MEDICARE: DR. MARC JOSEPH SICKLICK MD

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	207KA0200X	Allergy Physician	124343	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	GS315	OTHER	OXFORD
2	02200	OTHER	GHI
3	08A15	OTHER	BLUECROSS
4	226249	OTHER	UNITED
5	922147	OTHER	HEALTHNET

General Provider Information

NPI Number	:	1538163423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC JOSEPH SICKLICK MD

Provider Business Mailing Address
First Line	:	123 GROVE AVE
Second Line	:	STE 110
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2302
Country	:	US
Telephone Number	:	516-569-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 GROVE AVE
Second Line	:	STE 110
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2302
Country	:	US
Telephone Number	:	516-569-5550
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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