Healthcare Provider Details

I. General information

NPI: 1679010391
Provider Name (Legal Business Name): GREAT NECK PEDIATRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E SHORE RD 202
GREAT NECK NY
11023-2415
US

IV. Provider business mailing address

173 EAST SHORE RD 202
GREAT NECK NY
11023
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-4020
  • Fax: 516-487-4039
Mailing address:
  • Phone: 516-487-4020
  • Fax: 516-487-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GILBERT DICK
Title or Position: PRESIDENT
Credential: MD
Phone: 516-487-4020