Provider Demographics
NPI:1033289293
Name:HICKEY, BRIAN RICHARD
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:HICKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0310
Mailing Address - Country:US
Mailing Address - Phone:908-806-2645
Mailing Address - Fax:908-806-5228
Practice Address - Street 1:743 ALEXANDER ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6328
Practice Address - Country:US
Practice Address - Phone:609-419-0455
Practice Address - Fax:609-419-0023
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01177000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist