MEDICARE: DR. NIKA DYAKINA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	25MB08570600	NJ

General Provider Information

NPI Number	:	1699971937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKA DYAKINA D.O.

Provider Business Mailing Address
First Line	:	61 CREST RD
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1618
Country	:	US
Telephone Number	:	201-250-1579
Fax Number	:	201-283-9094

Provider Business Practice Location Address
First Line	:	1000 LAKE ST # 900C-6
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1249
Country	:	US
Telephone Number	:	201-250-1579
Fax Number	:	201-283-9094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	06/05/2024

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