1427059690 NPI number — MICHAEL D SIKORSKAS PT

Table of content: MICHAEL D SIKORSKAS PT (NPI 1427059690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427059690 NPI number — MICHAEL D SIKORSKAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIKORSKAS
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427059690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 ISLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCK HAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17745-8844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-748-2678
Provider Business Mailing Address Fax Number:
570-748-4015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 ISLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-8844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-2678
Provider Business Practice Location Address Fax Number:
570-748-4015
Provider Enumeration Date:
08/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT007553L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001874773 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 966897 . This is a "BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 151392 . This is a "HEALTH AMERICA-IND." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 813956 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".