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General NPI Number Information
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NPI Number | 1417368903
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Entity Type | Individual
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Provider Name | CARL DICKLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 425 W 59TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-8022
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Country | US
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Telephone | 212-523-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W 59TH ST FL 7
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City | NEW YORK
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State | NY
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Zip | 10019-8022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 303285
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License Number State | NY
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