Basic Information
| Provider Information | |||||||||
| NPI: | 1326110081 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SKYLIZARD | ||||||||
| FirstName: | LOKI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | DEPT 596 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662950041 | ||||||||
| FaxNumber: | 7083422517 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 MORRIS AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322635024 | ||||||||
| FaxNumber: | 7322635029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 219576 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | MD28398 | AL | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2086S0129X | MD442847 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | 25MA09252000 | NJ | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.