MARTHA MARY KICAK LPN
NPI 1104230317
Licensed Practical Nurse in Syracuse, NY

Q: What is Martha Kicak's NPI number?

The NPI number for Martha Kicak is 1104230317. It was assigned to this individual provider in the NPPES registry on June 16, 2014.

Q: What is Martha Kicak's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

Q: When was this NPI record last updated?

The NPPES record for Martha Kicak was last updated on June 16, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 16, 2014

2105 W GENESEE ST, SYRACUSE, NY 13219(315) 468-3239(315) 468-2917 Get Directions Write a Review

NPPES record last updated: June 16, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Martha Mary Kicak Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARTHA MARY KICAK LPN (NPI 1104230317) is an individual licensed practical nurse in Syracuse, New York, licensed in New York (082747) and active in the NPI registry since June 2014.

NPPES Registry Identity

NPI1104230317

Entity TypeIndividualFemale

Primary Taxonomy164W00000X

Provider Legal NameMARTHA MARY KICAKCredential: LPN

Location Address2105 W GENESEE STSyracuse, NY 13219-1656

Mailing Address4600 W Genesee St # 2105westSyracuse, NY 13219-1707 · (315) 468-3239 · Fax (315) 468-2917

Phone(315) 468-3239

Fax(315) 468-2917

Sole ProprietorNo

Enumeration DateJune 16, 2014

✔ NPI 1104230317 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers

Taxonomy Code164W00000X

License✔ Licensed in NY · 082747

Definition

A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

2105 W GENESEE ST, Syracuse, NY 13219

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Other Identifiers 2

Medicaid1609088871NY

Other082747NY · Lpn

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. RANDALL STETSON LCSW

Social Worker (Clinical)

2105 W GENESEE ST, STE 209
SYRACUSE, NY 13219

Onondaga County (315) 395-2893

ANGELA D BOOKER LPN

Licensed Practical Nurse