Provider Demographics
NPI:1720851231
Name:HICKEY, JAKE FRANCIS (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:FRANCIS
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CONRAD STRASSE
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3307
Mailing Address - Country:US
Mailing Address - Phone:973-527-5452
Mailing Address - Fax:
Practice Address - Street 1:400 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2184
Practice Address - Country:US
Practice Address - Phone:908-852-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT003195002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer