Provider Demographics
NPI:1801934013
Name:SIKORA, MAREK LEONARD (MD)
Entity type:Individual
Prefix:MR
First Name:MAREK
Middle Name:LEONARD
Last Name:SIKORA
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 1:65 04 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2423
Mailing Address - Country:US
Mailing Address - Phone:718-894-9274
Mailing Address - Fax:718-894-9753
Practice Address - Street 1:65 04 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2423
Practice Address - Country:US
Practice Address - Phone:718-894-9274
Practice Address - Fax:718-894-9753
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25037OtherGHI
NY28A711OtherB CROSS
NY25037Medicare ID - Type UnspecifiedGHI
NY28A711OtherB CROSS