Provider Demographics
NPI:1215972518
Name:SYCHIKOV, LUBOV (MD)
Entity type:Individual
Prefix:
First Name:LUBOV
Middle Name:
Last Name:SYCHIKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUBOV
Other - Middle Name:
Other - Last Name:SYCHIKOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:8615 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4427
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-397-7782
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00914838Medicaid
NYB58502Medicare UPIN
NY00914838Medicaid