Licata, Paul J
Licata, Paul J is an sole proprietor health care provider with primary practice located at 492 Montauk Ave , New London CT 06320-4615. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Licata, Paul J can be contacted via phone (860) 443-0305.Contact Information
Primary practice address
492 Montauk Ave
New London CT 06320-4615
Phone: (860) 443-0305
Fax: (860) 443-0823
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 000413 | Connecticut |
Profile Details
| NPI number | 1225036981 |
|---|---|
| LBN Legal business name | Licata, Paul J |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Oct 18th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225036981 | NPPES |
| Rhode Island | MEDICAID | PL52716 | |
| Rhode Island | MEDICAID | 001004134 | |
| Rhode Island | MEDICAID | 004242707 |
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