Provider Demographics
NPI:1952891491
Name:BICIC, MAHMUT
Entity Type:Individual
Prefix:
First Name:MAHMUT
Middle Name:
Last Name:BICIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6271 DRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1970
Mailing Address - Country:US
Mailing Address - Phone:718-606-6022
Mailing Address - Fax:718-898-8709
Practice Address - Street 1:6271 DRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1970
Practice Address - Country:US
Practice Address - Phone:718-606-6022
Practice Address - Fax:718-898-8709
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies