Provider Demographics
NPI:1396895017
Name:DR. JOHN J. HICKEY, D.P.M., P.L.L.C.
Entity type:Organization
Organization Name:DR. JOHN J. HICKEY, D.P.M., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-735-4545
Mailing Address - Street 1:2870 HEMPSTEAD TPKE STE 103
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1341
Mailing Address - Country:US
Mailing Address - Phone:516-735-4545
Mailing Address - Fax:516-735-2652
Practice Address - Street 1:2870 HEMPSTEAD TPKE STE 103
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1341
Practice Address - Country:US
Practice Address - Phone:516-735-4545
Practice Address - Fax:516-735-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWD81Medicare ID - Type Unspecified