Provider Demographics
NPI:1679565329
Name:FICKE, HENRY E (DPM)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:E
Last Name:FICKE
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 1:897 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1145
Mailing Address - Country:US
Mailing Address - Phone:201-306-7055
Mailing Address - Fax:
Practice Address - Street 1:444 AVENUE X
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6053
Practice Address - Country:US
Practice Address - Phone:718-375-1616
Practice Address - Fax:718-934-2225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005065213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540101Medicaid
2115165OtherAENTA US HEALTHCARE
NS4002OtherOXFORD HEALTH PLANS
P94231OtherEMPIRE BCBS SENIOR PLAN
6200812OtherGROUP HEALTH INCORPORATED
P60101OtherEMPIRE BLUE CROSS BLUE SH
P60103OtherEMPIRE BLUE CROSS BLUE SH
NYP60101OtherEMPIRE MEDICARE
P94232OtherEMPIRE BCBS SENIOR PLAN
NY01540101Medicaid
6200812OtherGROUP HEALTH INCORPORATED