Provider Demographics
NPI:1700092285
Name:SHICK, ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SHICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MAIN ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0190
Mailing Address - Country:US
Mailing Address - Phone:212-752-8722
Mailing Address - Fax:212-421-0790
Practice Address - Street 1:501 MAIN ST # A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0190
Practice Address - Country:US
Practice Address - Phone:212-752-8722
Practice Address - Fax:212-421-0790
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050025122300000X
NJ22DI02414200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist