Provider Demographics
NPI:1295838845
Name:DIKENGIL, ASIM G (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIM
Middle Name:G
Last Name:DIKENGIL
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 1:736 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071
Mailing Address - Country:US
Mailing Address - Phone:201-729-1234
Mailing Address - Fax:201-729-1150
Practice Address - Street 1:736 PAGE AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071
Practice Address - Country:US
Practice Address - Phone:201-729-1234
Practice Address - Fax:201-729-1150
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA442342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040470OtherMCARE
NJ1436601Medicaid
NY40F111OtherMCARE
A64267Medicare UPIN
NJ541420Medicare ID - Type Unspecified