Healthcare Provider Details

I. General information

NPI: 1891882973
Provider Name (Legal Business Name): ROMAN DYKYJ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 REVERE ST
PHILADELPHIA PA
19152-3002
US

IV. Provider business mailing address

8151 REVERE ST
PHILADELPHIA PA
19152-3002
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-3000
  • Fax: 215-624-6855
Mailing address:
  • Phone: 215-624-3000
  • Fax: 215-624-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD027187E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: