Provider Demographics
NPI:1609272848
Name:BICK-O'CONNOR, JAIMIE (DPT)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:BICK-O'CONNOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:
Other - Last Name:BICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:731 LACEY RD
Practice Address - Street 2:STE 3
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1364
Practice Address - Country:US
Practice Address - Phone:609-242-6780
Practice Address - Fax:609-242-6783
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01565300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist