Individual
JEFFREY PAUL LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3333 HYLAN BLVD, STATEN ISLAND, NY 10306-3608
(718) 667-7500
Mailing address
3333 HYLAN BLVD, STATEN ISLAND, NY 10306-3608
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
031134
NY
363AM0700X
Medical Physician Assistant
25MP00516300
NJ
Other
Enumeration date
03/19/2019
Last updated
12/19/2023
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