Basic Information
Provider Information
NPI: 1033557772
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DICHTER
FirstName: ERIC
MiddleName: KYLE
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5 TYLERS COURT
Address2:  
City: SOMERDALE
State: NJ
PostalCode: 08083
CountryCode: US
TelephoneNumber: 8563049881
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER DR
Address2:  
City: STRATFORD
State: NJ
PostalCode: 080841500
CountryCode: US
TelephoneNumber: 8565667050
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2013
LastUpdateDate: 06/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XOS14746FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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