Provider Demographics
NPI:1528145059
Name:DICKER, PAUL M (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
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 1:270 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3117
Mailing Address - Country:US
Mailing Address - Phone:201-358-0505
Mailing Address - Fax:201-497-1133
Practice Address - Street 1:270 OLD HOOK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3117
Practice Address - Country:US
Practice Address - Phone:201-358-0505
Practice Address - Fax:201-497-1133
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06343000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21201Medicare UPIN