Provider Demographics
NPI:1093829699
Name:SKLAR, MICHAEL B (NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:SKLAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:92 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4122
Mailing Address - Country:US
Mailing Address - Phone:516-541-2355
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:PRIMARY CARE
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6051
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340057-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology