Provider Demographics
NPI:1043376189
Name:HICKEY, JOHN JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 HEMPSTEAD TPKE STE 103
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1341
Mailing Address - Country:US
Mailing Address - Phone:516-735-4545
Mailing Address - Fax:516-735-2652
Practice Address - Street 1:2870 HEMPSTEAD TPKE STE 103
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1341
Practice Address - Country:US
Practice Address - Phone:516-735-4545
Practice Address - Fax:516-735-2652
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3381213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00737839Medicaid
PB6641Medicare ID - Type Unspecified
T71183Medicare UPIN