Provider Demographics
NPI:1770901845
Name:LEON DICK, MD PA
Entity type:Organization
Organization Name:LEON DICK, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:S
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-763-8087
Mailing Address - Street 1:2232 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2605
Mailing Address - Country:US
Mailing Address - Phone:973-763-8087
Mailing Address - Fax:973-763-6482
Practice Address - Street 1:2232 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2605
Practice Address - Country:US
Practice Address - Phone:973-763-8087
Practice Address - Fax:973-763-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03208100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty