MEDICARE: HENRY S. BYLICKY,JR.,D.D.S.,P.C.

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1952322752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY S. BYLICKY,JR.,D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	77 MAIN ST
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3109
Country	:	US
Telephone Number	:	845-727-4122
Fax Number	:	845-358-2465

Provider Business Practice Location Address
First Line	:	77 MAIN ST
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3109
Country	:	US
Telephone Number	:	845-727-4122
Fax Number	:	845-358-2465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY STANLEY BYLICKY JR.
Credential	:	D.D.S.
Telephone Number	:	845-727-4122

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	11/18/2011

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