Basic Information
| Provider Information | |||||||||
| NPI: | 1447635966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SICA | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 RIDGE MILLS RD | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134402203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153372500 | ||||||||
| FaxNumber: | 3153370720 | ||||||||
| Practice Location | |||||||||
| Address1: | 7901 RIDGE MILLS RD | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134402203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153372500 | ||||||||
| FaxNumber: | 3153370720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2015 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 339870 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.