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NPI Code Detail

MEDICARE: DEAN PETER LICOPANTIS DPM

MEDICARE: DEAN PETER LICOPANTIS DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist25MD001877NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
224223299834OTHERNJBLUE CROSS

General Provider Information

NPI Number : 1760478010
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN PETER LICOPANTIS DPM
Provider Business Mailing Address
First Line : 16 POCONO RD
Second Line : #209
City : DENVILLE
State : NJ
Zip : 07834-2901
Country : US
Telephone Number : 973-331-7900
Fax Number : 973-331-7999
Provider Business Practice Location Address
First Line : 16 POCONO RD
Second Line : #209
City : DENVILLE
State : NJ
Zip : 07834-2901
Country : US
Telephone Number : 973-331-7900
Fax Number : 973-331-7999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 01/15/2014

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Directions to “ DEAN PETER LICOPANTIS DPM” Practice Location

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