Provider Demographics
NPI:1750477725
Name:HICKS, STEVEN DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DAVID
Last Name:HICKS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1783 ROUTE 9
Practice Address - Street 2:SUITE 101
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2409
Practice Address - Country:US
Practice Address - Phone:518-782-3810
Practice Address - Fax:518-782-3838
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-08-29
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Provider Licenses
StateLicense IDTaxonomies
NY009758-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02626048Medicaid
NYJ400286416Medicare PIN
NYQ27758Medicare UPIN