1619973898 NPI number — DR. STEVEN B DICKERT D.C.

Table of content: DR. STEVEN B DICKERT D.C. (NPI 1619973898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619973898 NPI number — DR. STEVEN B DICKERT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKERT
Provider First Name:
STEVEN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1619973898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 WETHERHILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08810-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-329-2255
Provider Business Mailing Address Fax Number:
732-329-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 WETHERHILL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08810-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-329-2255
Provider Business Practice Location Address Fax Number:
732-329-2228
Provider Enumeration Date:
06/22/2005

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: 111N00000X , with the licence number:  MC02937 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: X003329 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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