Joseph Dic, D.O.
Individual provider Active NPI Family Medicine Physician · Deer Park, NY
NPI 1376569707 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376569707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 163417 (NY)
- Practice address
- 2005 Deer Park Ave
Suite D
Deer Park, NY 11729-2700 - Phone
- (631) 243-6690
- Fax
- (631) 595-1502
- NPI assigned
- Jul 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101118001275 | NY | Practitioner - Family Practice | 5395931109 | Practice locations: Deer Park, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 163417 | NY | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 163417 | NY | Yes |
Addresses
Primary practice location
2005 Deer Park Ave
Suite D
Deer Park, NY 11729-2700
Mailing address
2005 Deer Park Ave
Suite D
Deer Park, NY 11729-2700
Phone (631) 243-6690
Other providers in Deer Park, NY
- Amanda Denzler
- Nisha Desai
- Tasha Dhawan
- Kristin Diamandis
- Erika Diaz
- Robert Nicholas Digiovanna
- Kristen Noel Dileo
- Francine Pierna Dimaria
- Maricris G Diola
- Joann Doherty
All providers in Deer Park, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.