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General NPI Number Information
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NPI Number | 1720047525
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Entity Type | Individual
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Provider Name | LUCIAN V DAJDEA MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6685 FOREST AVENUE FOREST MEDICAL PC
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-456-9733
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Fax | 718-418-2547
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Provider Business Mailing Address
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Address Line | 6685 FOREST AVENUE FOREST MEDICAL PC
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-456-9733
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Fax | 718-418-2547
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 153356
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License Number State | NY
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