Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA03883000 | NJ |
Y | 2080A0000X | Adolescent Medicine | MA033883000 | NJ |
NPI | 1154436863 |
---|---|
Provider Name | Dr. Richard I Dicker |
First Address | West Caldwell, NJ 07006-6514 |
Second Address | Denville, NJ 07834-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 03/01/2018 |