Individual
MATTHEW KLICS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
635 BELLE TERRE RD, SUITE 204, PORT JEFFERSON, NY 11777-1935
(631) 474-0008
Mailing address
635 BELLE TERRE RD, SUITE 204, PORT JEFFERSON, NY 11777-1935
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0200111
NY
Other
Enumeration date
08/12/2016
Last updated
10/19/2016
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