Provider Demographics
NPI:1376782219
Name:HICKMAN, ZACHARY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:LEE
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MADISON AVE APT 26G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5550
Mailing Address - Country:US
Mailing Address - Phone:917-232-4805
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY STE D6-15
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2772
Practice Address - Fax:718-334-2765
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280019207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery