Healthcare Provider Details

I. General information

NPI: 1730156225
Provider Name (Legal Business Name): JAMES N ICKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CENTRAL PARK S APT 107
NEW YORK NY
10019-1449
US

IV. Provider business mailing address

200 CENTRAL PARK S APT 107
NEW YORK NY
10019-1449
US

V. Phone/Fax

Practice location:
  • Phone: 212-262-2500
  • Fax: 212-765-3210
Mailing address:
  • Phone: 212-262-2500
  • Fax: 212-765-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2001219
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number295696-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: