Provider Demographics
NPI:1154436863
Name:DICKER, RICHARD I (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:DICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6514
Mailing Address - Country:US
Mailing Address - Phone:973-228-5934
Mailing Address - Fax:
Practice Address - Street 1:10 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2704
Practice Address - Country:US
Practice Address - Phone:973-625-7734
Practice Address - Fax:973-625-4821
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03883000207Q00000X
NJMA0338830002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine