Individual
HAROLD MITCHELL TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
229 BROADWAY, LYNBROOK, NY 11563-3295
(516) 256-1558
(516) 256-0758
Mailing address
110 MARCUS DR, MELVILLE, NY 11747-4228
(631) 390-1793
(631) 390-1780
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
169078
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01468588
—
NY
Enumeration date
10/25/2005
Last updated
09/13/2013
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