Healthcare Provider Details

I. General information

NPI: 1619064060
Provider Name (Legal Business Name): TROY E DICKINSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

325 E MAIN ST STE 120
PATCHOGUE NY
11772-3114
US

V. Phone/Fax

Practice location:
  • Phone: 631-394-2550
  • Fax: 631-772-2495
Mailing address:
  • Phone: 631-659-8301
  • Fax: 631-654-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: