MEDICARE: JEAN DICKER CDN

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
1	133V00000X	Registered Dietitian	003312-1	NY

General Provider Information

NPI Number	:	1821277476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN DICKER CDN

Provider Business Mailing Address
First Line	:	3347 14TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4677
Country	:	US
Telephone Number	:	718-217-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 14TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4677
Country	:	US
Telephone Number	:	718-217-5274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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Directions to “ JEAN DICKER CDN” Practice Location

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