Provider Demographics
NPI:1164488284
Name:HICKS HARTMAN, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:HICKS HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MARGARET
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:574 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1001
Mailing Address - Country:US
Mailing Address - Phone:908-389-6366
Mailing Address - Fax:908-673-7265
Practice Address - Street 1:574 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1001
Practice Address - Country:US
Practice Address - Phone:908-389-6366
Practice Address - Fax:908-673-7265
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38070207KA0200X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56319Medicare UPIN
NJ199715Medicare PIN