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General NPI Number Information
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NPI Number | 1811019995
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Entity Type | Organization
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Legal Business Name | PEDIATRICS ON BROADWAY
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 BROADWAY
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City | DENVILLE
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State | NJ
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Zip | 07834-2704
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Country | US
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Telephone | 973-625-7734
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Fax | 973-625-4821
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Provider Business Mailing Address
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Address Line | 10 BROADWAY
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City | DENVILLE
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State | NJ
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Zip | 07834-2704
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Country | US
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Telephone | 973-625-7734
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Fax | 973-625-4821
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD DICKER
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Credential | MD
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Telephone | 973-625-7734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | NJ
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