Provider Demographics
NPI:1912065392
Name:ROBERT G HICKES MD PC
Entity Type:Organization
Organization Name:ROBERT G HICKES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HICKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:607-272-5486
Mailing Address - Street 1:821 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2017
Mailing Address - Country:US
Mailing Address - Phone:607-272-5486
Mailing Address - Fax:607-272-5966
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2017
Practice Address - Country:US
Practice Address - Phone:607-272-5486
Practice Address - Fax:607-272-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113067173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00602502Medicaid
NY00602502Medicaid
NYB81390Medicare UPIN