Healthcare Provider Details

I. General information

NPI: 1003109893
Provider Name (Legal Business Name): ERIK DIENNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 NORTHFIELD AVE STE 7
WEST ORANGE NJ
07052-1136
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10, SUITE 320
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-0002
  • Fax: 855-274-7153
Mailing address:
  • Phone: 973-243-0002
  • Fax: 855-274-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09966600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: