Provider Demographics
NPI:1457619017
Name:HIKIN, DIMITRY (DO)
Entity Type:Individual
Prefix:DR
First Name:DIMITRY
Middle Name:
Last Name:HIKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W 57TH ST APT 19L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5106 VERNON BLVD
Practice Address - Street 2:STE 202
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5906
Practice Address - Country:US
Practice Address - Phone:646-837-7733
Practice Address - Fax:718-784-6288
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253177282N00000X
NY25317712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology