Provider Demographics
NPI:1467631655
Name:HARVEY R. DANCIGER
Entity Type:Organization
Organization Name:HARVEY R. DANCIGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DANCIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-568-0108
Mailing Address - Street 1:74000 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1685
Mailing Address - Country:US
Mailing Address - Phone:760-568-0108
Mailing Address - Fax:760-568-5110
Practice Address - Street 1:74000 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A-2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1685
Practice Address - Country:US
Practice Address - Phone:760-568-0108
Practice Address - Fax:760-568-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E21790Medicare PIN
4810240001Medicare NSC
T19171Medicare UPIN