Healthcare Provider Details

I. General information

NPI: 1033133129
Provider Name (Legal Business Name): JOHN HICKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TEDDINGTON WAY
MOUNT LAUREL NJ
08054-6200
US

IV. Provider business mailing address

6 TEDDINGTON WAY
MOUNT LAUREL NJ
08054-6200
US

V. Phone/Fax

Practice location:
  • Phone: 856-904-0922
  • Fax:
Mailing address:
  • Phone: 856-904-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-024917-E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2255901
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: