Provider Demographics
NPI:1083808851
Name:BICKEL, BRITTANI LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:LEIGH
Last Name:BICKEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W BARNEY ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1040
Mailing Address - Country:US
Mailing Address - Phone:315-287-1000
Mailing Address - Fax:
Practice Address - Street 1:2924 COUNTY ROUTE 17
Practice Address - Street 2:
Practice Address - City:DEKALB JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:13630
Practice Address - Country:US
Practice Address - Phone:315-347-3830
Practice Address - Fax:315-347-3840
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03470188Medicaid
NY03470188Medicaid