Organization
ROMAN DYKYJ JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROMAN DYKYJ JR. MD (PRESIDENT)
(215) 624-3000
Entity
Organization
Contact information
Practice address
8151 REVERE ST, PHILADELPHIA, PA 19152-3002
(215) 624-6855
Mailing address
8151 REVERE ST, PHILADELPHIA, PA 19152-3002
(215) 624-6855
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD027187E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054192000
INDEPENDENT BLUE CROSS
PA
01
—
0054192001
KEYSTONE HPE
PA
01
—
2061288
AETNA
PA
01
—
A00995
AMERIHEALTH ADMINISTRATOR
PA
Enumeration date
01/16/2008
Last updated
01/21/2008
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