Provider Demographics
NPI:1437169117
Name:DICKER, MORDECAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MORDECAI
Middle Name:
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 1:233 E SHORE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2433
Mailing Address - Country:US
Mailing Address - Phone:516-487-2444
Mailing Address - Fax:516-487-2446
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:STE 101
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-487-2444
Practice Address - Fax:516-487-2446
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178718207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE95846Medicare UPIN
NY98F381Medicare ID - Type Unspecified