Individual
DR. SCOTT MICHAEL STICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8940 56TH AVE, ELMHURST, NY 11373-4933
(718) 335-5532
(718) 505-0241
Mailing address
PO BOX 6257, ASTORIA, NY 11106-0257
(718) 204-4995
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
248461-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03109551
—
NY
Enumeration date
06/06/2008
Last updated
08/06/2012
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