=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619064060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TROY E DICKINSON DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 E MAIN ST
-----------------------------------------------------
City | PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-394-2550
-----------------------------------------------------
Fax | 631-772-2495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 E MAIN ST STE 120
-----------------------------------------------------
City | PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-659-8301
-----------------------------------------------------
Fax | 631-654-1474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 209958
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------