Nicholas Licciardello, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

021389 Issued in NY

Practice address

8900 Van Wyck Expy
Richmond Hill, NY 11418-2832

Phone

(347) 942-4099

NPI assigned

Oct 10, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• TJH Medical Services, P.C.

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1184670465
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1588174122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2326 FISH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695746",
            "telephone_number": "347-942-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 VAN WYCK EXPY",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114182832",
            "telephone_number": "347-942-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICCIARDELLO",
        "first_name": "NICHOLAS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "021389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Legendary Therapy
• Sharene R Lewis, M.S.,CCC-SLP
• Gustavo Leyva, CASAC TRAINEE
• Xun Li, M.D.
• Liberty Chemists Inc
• Hyomin Lim, M.D.
• Mia Grace Mary Lim
• Kerry Lin
• Margaret Lin
• Anthony J Liotta, MSW

• Medical Physician Assistant in Richmond Hill, NY
• Providers in Richmond Hill, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.