Provider Demographics
NPI:1821177825
Name:KULIKOV, SERGEY K (DO)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:K
Last Name:KULIKOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 MEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3603
Mailing Address - Country:US
Mailing Address - Phone:516-379-8006
Mailing Address - Fax:516-379-5509
Practice Address - Street 1:10 FRANKLIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4501
Practice Address - Country:US
Practice Address - Phone:516-889-0100
Practice Address - Fax:516-897-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01861201Medicaid
NY07V591Medicare ID - Type Unspecified
NY01861201Medicaid