Provider Demographics
NPI:1659033660
Name:LODICO, ALICIA N (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:LODICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:N
Other - Last Name:LODICO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2 PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1552
Mailing Address - Country:US
Mailing Address - Phone:845-837-9818
Mailing Address - Fax:
Practice Address - Street 1:2 PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1552
Practice Address - Country:US
Practice Address - Phone:845-837-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319577164W00000X
NY872767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY319577Medicaid