Provider Demographics
NPI:1902049067
Name:DICKSTEIN, DEBORAH BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:BARBARA
Last Name:DICKSTEIN
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 1:680 W END AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6815
Mailing Address - Country:US
Mailing Address - Phone:212-665-3785
Mailing Address - Fax:
Practice Address - Street 1:680 W END AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6815
Practice Address - Country:US
Practice Address - Phone:212-665-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1868572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02J22-1Medicare PIN
NYF90154Medicare UPIN