Provider Demographics
NPI:1255435665
Name:LICLICAN, ARTHUR CALICA (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:CALICA
Last Name:LICLICAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798
Mailing Address - Country:US
Mailing Address - Phone:631-854-1700
Mailing Address - Fax:
Practice Address - Street 1:1556 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798
Practice Address - Country:US
Practice Address - Phone:631-854-1700
Practice Address - Fax:631-854-1786
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211972Medicaid
B16811Medicare UPIN
NY577231Medicare Oscar/Certification