Provider Demographics
NPI:1073698957
Name:LICKFIELD MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:LICKFIELD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LICKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-663-4060
Mailing Address - Street 1:5521 WESTFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1820
Mailing Address - Country:US
Mailing Address - Phone:856-663-4060
Mailing Address - Fax:856-663-7530
Practice Address - Street 1:5521 WESTFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1820
Practice Address - Country:US
Practice Address - Phone:856-663-4060
Practice Address - Fax:856-663-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty