Provider Demographics
NPI:1134292527
Name:SICKLES, ALAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:SICKLES
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 1:247 3RD AVE
Mailing Address - Street 2:SUITE L-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7457
Mailing Address - Country:US
Mailing Address - Phone:212-533-8600
Mailing Address - Fax:212-533-2965
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE L-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:212-533-8600
Practice Address - Fax:212-533-2965
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14E111Medicare ID - Type Unspecified
NYA60706Medicare UPIN