Provider Demographics
NPI:1134777428
Name:DIKAN, SERGEY
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:DIKAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3104
Mailing Address - Country:US
Mailing Address - Phone:413-335-4366
Mailing Address - Fax:413-426-4762
Practice Address - Street 1:58 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1840
Practice Address - Country:US
Practice Address - Phone:413-335-4366
Practice Address - Fax:413-426-4762
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS26191873343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)