Healthcare Provider Details

I. General information

NPI: 1396895017
Provider Name (Legal Business Name): DR. JOHN J. HICKEY, D.P.M., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 HEMPSTEAD TPKE STE 103
LEVITTOWN NY
11756-1341
US

IV. Provider business mailing address

2870 HEMPSTEAD TPKE STE 103
LEVITTOWN NY
11756-1341
US

V. Phone/Fax

Practice location:
  • Phone: 516-735-4545
  • Fax: 516-735-2652
Mailing address:
  • Phone: 516-735-4545
  • Fax: 516-735-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOHN J HICKEY
Title or Position: OFFICER
Credential: DPM
Phone: 516-735-4545