1679565329 NPI number — HENRY E FICKE DPM

Table of content: HENRY E FICKE DPM (NPI 1679565329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679565329 NPI number — HENRY E FICKE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FICKE
Provider First Name:
HENRY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679565329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
897 ELM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07657-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-306-7055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 AVENUE X
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223-6053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-1616
Provider Business Practice Location Address Fax Number:
718-934-2225
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N005065 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01540101 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2115165 . This is a "AENTA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NS4002 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P94231 . This is a "EMPIRE BCBS SENIOR PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6200812 . This is a "GROUP HEALTH INCORPORATED" identifier . This identifiers is of the category "OTHER".
  • Identifier: P60101 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P60103 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P60101 . This is a "EMPIRE MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P94232 . This is a "EMPIRE BCBS SENIOR PLAN" identifier . This identifiers is of the category "OTHER".




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