Provider Demographics
NPI:1871049296
Name:FICKENS, EUGENIA
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:FICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 27TH AVE
Mailing Address - Street 2:APT. 318
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3920
Mailing Address - Country:US
Mailing Address - Phone:347-447-4122
Mailing Address - Fax:
Practice Address - Street 1:810 27TH AVE
Practice Address - Street 2:APT. 318
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-3920
Practice Address - Country:US
Practice Address - Phone:347-447-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency