Healthcare Provider Details

I. General information

NPI: 1902863244
Provider Name (Legal Business Name): THOMAS E FICKETT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ELMVIEW AVENUE HAMBURG HEALTH CENTER
HAMBURG NY
14075
US

IV. Provider business mailing address

120 GARDENVILLE PKWY W ATTN: BETTY PICCILLO
WEST SENECA NY
14224-1324
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-3040
  • Fax: 716-656-4254
Mailing address:
  • Phone: 716-857-6150
  • Fax: 716-656-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3001571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: