Provider Demographics
NPI:1053325563
Name:BICKOFF, COREY IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:IAN
Last Name:BICKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 W MERRICK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3374
Mailing Address - Country:US
Mailing Address - Phone:516-223-3337
Mailing Address - Fax:516-223-3469
Practice Address - Street 1:294 W MERRICK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3374
Practice Address - Country:US
Practice Address - Phone:516-223-3337
Practice Address - Fax:516-223-3469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06352OtherGHI MEDICARE
NY01760801Medicaid
NY06352OtherGHI MEDICARE
NY01760801Medicaid