Provider Demographics
NPI:1952320103
Name:SICHERMAN, HARLAN J (MD)
Entity Type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:J
Last Name:SICHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0290
Mailing Address - Fax:732-238-0936
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5405
Practice Address - Country:US
Practice Address - Phone:732-390-0290
Practice Address - Fax:732-238-0936
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03455700207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07052Medicare UPIN
NJ542913Medicare PIN