Lynn Hickox, NP;CNM
Individual provider Active NPI Midwife · E Syracuse, NY
NPI 1609871003 · NPPES record last updated Dec 21, 2021
Key facts
- NPI
- 1609871003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- F000673 (NY)
- Practice address
- 824 Franklin PK Dr
E Syracuse, NY 13057 - Phone
- (315) 432-1048
- Fax
- (315) 432-9219
- NPI assigned
- Jun 14, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180808000084 | NY | Practitioner - Certified Nurse Midwife (CNM) | 8729376058 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F000673 | NY | MD | Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upstate Community Medical, PC | Current |
Accepting new patients | |
| Mark Antosh MD PC | Current |
Accepting new patients | |
| David M. Girardi, OD, LLC | Past |
Accepting new patients |
Locations
824 Franklin Park Dr
East Syracuse, NY 13057
Phone (315) 432-1048
4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011
1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488
4900 Broad Rd
Ste 4H
Syracuse, NY 13215
Phone (315) 492-5678
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | F000673 | NY | Yes |
Addresses
Primary practice location
824 Franklin PK Dr
E Syracuse, NY 13057
Mailing address
824 Franklin PK Dr
E Syracuse, NY 13057
Phone (315) 432-1048
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01763193 | Medicaid | NY | |
| 000013877 | Other | NY | BC/BS |
| 161529574 | Other | NY | TAX ID |
| 000916155001 | Other | NY | HEALTHNOW |
| 040426015267 | Other | NY | FIDELIS |
| 1899983 | Other | NY | GHI |
| 5626602 | Other | NY | AETNA |
Other providers in E Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.