Healthcare Provider Details

I. General information

NPI: 1528145059
Provider Name (Legal Business Name): PAUL M DICKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 OLD HOOK RD 2ND FLOOR
WESTWOOD NJ
07675-3117
US

IV. Provider business mailing address

270 OLD HOOK RD 2ND FLOOR
WESTWOOD NJ
07675-3117
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-0505
  • Fax: 201-497-1133
Mailing address:
  • Phone: 201-358-0505
  • Fax: 201-497-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA06343000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: