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General NPI Number Information
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NPI Number | 1366552507
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Entity Type | Individual
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Provider Name | LINDA WICKES PA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 170 W 12TH ST ST VINCENT'S HOSPITAL
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City | NEW YORK
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State | NY
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Zip | 10011-8202
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Country | US
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Telephone | 212-604-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 717
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City | LIVINGSTON
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State | NJ
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Zip | 07039
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Country | US
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Telephone | 973-740-0607
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Fax | 973-422-0353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00029800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6465
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License Number State | NY
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