Provider Demographics
NPI:1124899869
Name:HICKORY CARE LLC
Entity type:Organization
Organization Name:HICKORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEFERKORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-930-9911
Mailing Address - Street 1:52 HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5841
Mailing Address - Country:US
Mailing Address - Phone:732-631-4358
Mailing Address - Fax:
Practice Address - Street 1:1700 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6672
Practice Address - Country:US
Practice Address - Phone:407-647-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty