1225037187 NPI number — PETER CECIL TAYLOR DICKINSON M.D.

Table of content: PETER CECIL TAYLOR DICKINSON M.D. (NPI 1225037187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225037187 NPI number — PETER CECIL TAYLOR DICKINSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKINSON
Provider First Name:
PETER CECIL
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225037187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CROSFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WEST NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10994-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-358-1344
Provider Business Mailing Address Fax Number:
845-348-8578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CROSFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-358-1344
Provider Business Practice Location Address Fax Number:
845-348-8578
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  122936 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00815912 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2X4222 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com