Provider Demographics
NPI:1487636858
Name:HARDICK DACKO, ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:HARDICK DACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20408 ROCKAWAY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1115
Mailing Address - Country:US
Mailing Address - Phone:646-421-6064
Mailing Address - Fax:646-843-4701
Practice Address - Street 1:20408 ROCKAWAY POINT BLVD
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697
Practice Address - Country:US
Practice Address - Phone:646-421-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2064399207ND0101X
NY220931207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161379Medicaid
NYWZYQX1Medicare PIN
NY2K381ZYQX1Medicare PIN
NY02161379Medicaid
NY02161379Medicaid