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General NPI Number Information
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NPI Number | 1689850901
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Entity Type | Organization
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Legal Business Name | ROMAN DYKYJ JR MD PC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/21/2008
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Provider Practice Location Address
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Address Line | 8151 REVERE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3002
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Country | US
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Telephone | 215-624-6855
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Fax |
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Provider Business Mailing Address
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Address Line | 8151 REVERE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3002
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Country | US
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Telephone | 215-624-6855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROMAN DYKYJ JR.
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Credential | MD
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Telephone | 215-624-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD027187E
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License Number State | PA
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