Provider Demographics
NPI:1992830202
Name:TRICARICO-FLOMAN, LEE ANN (PA)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:TRICARICO-FLOMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 PULASKI RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1605
Mailing Address - Country:US
Mailing Address - Phone:631-423-1414
Mailing Address - Fax:631-423-4902
Practice Address - Street 1:270 PULASKI RD STE A
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1605
Practice Address - Country:US
Practice Address - Phone:631-423-1414
Practice Address - Fax:631-423-4902
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant