Provider Demographics
NPI:1730241316
Name:SHARMA, MICKEY PRADEEP (MD)
Entity type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:PRADEEP
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 RAMAPO RD
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1718
Mailing Address - Country:US
Mailing Address - Phone:845-947-2232
Mailing Address - Fax:845-947-1339
Practice Address - Street 1:66 RAMAPO RD
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1718
Practice Address - Country:US
Practice Address - Phone:845-947-2232
Practice Address - Fax:845-947-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217358207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02088851Medicaid
NY02088851Medicaid
NY60C881Medicare ID - Type Unspecified