MEDICARE: DR. DIMITRY HIKIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	253177	NY
2	2085R0202X	Diagnostic Radiology Physician	2531771	NY
3	2085R0202X	Diagnostic Radiology Physician	OS18032	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	FL	HFMG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457619017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMITRY HIKIN D.O.

Provider Business Mailing Address
First Line	:	322 W 57TH ST APT 19L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-0004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5106 VERNON BLVD
Second Line	:	STE 202
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5906
Country	:	US
Telephone Number	:	646-837-7733
Fax Number	:	718-784-6288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	12/05/2025

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