Provider Demographics
NPI:1154682300
Name:ICKOVITZ, PESSIE (BS)
Entity Type:Individual
Prefix:MS
First Name:PESSIE
Middle Name:
Last Name:ICKOVITZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5421
Mailing Address - Country:US
Mailing Address - Phone:718-677-4877
Mailing Address - Fax:718-534-0359
Practice Address - Street 1:3321 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5421
Practice Address - Country:US
Practice Address - Phone:718-677-4877
Practice Address - Fax:718-534-0359
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator