Provider Demographics
NPI:1134880842
Name:HICKS, QUINTON T
Entity type:Individual
Prefix:MR
First Name:QUINTON
Middle Name:T
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2328
Mailing Address - Country:US
Mailing Address - Phone:585-378-6586
Mailing Address - Fax:
Practice Address - Street 1:314 N 7TH ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2328
Practice Address - Country:US
Practice Address - Phone:585-378-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY518500334344600000X
518500334344600000X
NY518500324344600000X
344600000X
NY344600000X
NY34460000X344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY518500334OtherDMV