Eric John Dieckmann
Individual provider Active NPI Specialist · Brightwaters, NY
NPI 1427312271 · NPPES record last updated Jun 26, 2012
Key facts
- NPI
- 1427312271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 548 Pine Dr
Brightwaters, NY 11718-1728 - Phone
- (631) 332-2841
- NPI assigned
- Jun 26, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NY | Yes |
Addresses
Primary practice location
548 Pine Dr
Brightwaters, NY 11718-1728
Mailing address
548 Pine Dr
Brightwaters, NY 11718-1728
Phone (631) 332-2841
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1785977 | Other | NY | PUBLIC SCHOOL TEACHER CERTIFICATE |
Other providers in Brightwaters, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.