Provider Demographics
NPI:1063750834
Name:TICITL, T'KARIMA (PHD, CM, LM)
Entity type:Individual
Prefix:DR
First Name:T'KARIMA
Middle Name:
Last Name:TICITL
Suffix:
Gender:F
Credentials:PHD, CM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1214
Mailing Address - Country:US
Mailing Address - Phone:917-284-7791
Mailing Address - Fax:
Practice Address - Street 1:72 GASKILL AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3423
Practice Address - Country:US
Practice Address - Phone:917-284-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001975367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife