Individual
DR. MICHAEL LICATA
Active
Individual
DR. MICHAEL LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
184241-1
NY
2085R0202X
Diagnostic Radiology Physician
184241
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026372703
UNIVERA HEALTHCARE
NY
01
—
000523460013
BCBS
NY
05
—
01528734
—
NY
01
—
040426000284
FIDELIS CARE OF NEW YORK
NY
01
—
113586FF
PREFERRED CARE
NY
01
—
1609206
INDEPENDENT HEALTH
NY
01
—
300080525
RR MEDICARE
NY
Enumeration date
03/14/2006
Last updated
09/16/2013
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