Provider Demographics
NPI:1669244414
Name:SARIKOV, MICHAL MICHELLE
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:MICHELLE
Last Name:SARIKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 72ND RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2317
Mailing Address - Country:US
Mailing Address - Phone:929-215-5504
Mailing Address - Fax:
Practice Address - Street 1:13712 72ND RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2317
Practice Address - Country:US
Practice Address - Phone:929-215-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist