Provider Demographics
NPI:1245539071
Name:DISSICK MEDICAL ASSOCIATES,PA
Entity type:Organization
Organization Name:DISSICK MEDICAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-672-7950
Mailing Address - Street 1:7301A PALMETTO PARK ROAD
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-672-7950
Mailing Address - Fax:561-672-7953
Practice Address - Street 1:7301A PALMETTO PARK ROAD
Practice Address - Street 2:SUITE 301A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-672-7950
Practice Address - Fax:561-672-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty