Provider Demographics
NPI:1275873648
Name:COREY BICKOFF MD PC
Entity Type:Organization
Organization Name:COREY BICKOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:BICKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-223-3337
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY388B81OtherMC PTAN