Healthcare Provider Details

I. General information

NPI: 1306398706
Provider Name (Legal Business Name): DONNA LEE HICKEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA LEE HICKEY RDH

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 STEWART AVE
GARDEN CITY NY
11530-4893
US

IV. Provider business mailing address

110 BROADWAY
BETHPAGE NY
11714-4904
US

V. Phone/Fax

Practice location:
  • Phone: 516-747-2400
  • Fax:
Mailing address:
  • Phone: 516-931-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number019414-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: