Provider Demographics
NPI:1033970447
Name:HIXON, ESTELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:HIXON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 2ND AVE RM 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4534
Mailing Address - Country:US
Mailing Address - Phone:212-661-3376
Mailing Address - Fax:
Practice Address - Street 1:820 2ND AVE RM 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4534
Practice Address - Country:US
Practice Address - Phone:212-661-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant