1144360629 NPI number — DR. ROBBAN ARIEL SICA M.D.

Table of content: DR. ROBBAN ARIEL SICA M.D. (NPI 1144360629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144360629 NPI number — DR. ROBBAN ARIEL SICA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SICA
Provider First Name:
ROBBAN
Provider Middle Name:
ARIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1144360629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-0172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-799-7733
Provider Business Mailing Address Fax Number:
203-987-4853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C/O WEST PORT INTEGRATIVE MEDICINE, LLC SUITE 100
Provider Second Line Business Practice Location Address:
1 TURKEY HILL ROAD SOUTH
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-799-7733
Provider Business Practice Location Address Fax Number:
203-987-4853
Provider Enumeration Date:
02/07/2007

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: 207R00000X , with the licence number:  026453 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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