Individual
MR. NICHOLAS LICCIARDELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8900 VAN WYCK EXPY, RICHMOND HILL, NY 11418-2832
(347) 942-4099
Mailing address
2326 FISH AVE, BRONX, NY 10469-5746
(347) 942-4099
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
021389
NY
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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