Individual
DEAN PETER LICOPANTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
16 POCONO RD, #209, DENVILLE, NJ 07834-2901
(973) 331-7900
(973) 331-7999
Mailing address
16 POCONO RD, #209, DENVILLE, NJ 07834-2901
(973) 331-7900
(973) 331-7999
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD001877
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0943908
—
NJ
01
—
24223299834
BLUE CROSS
NJ
Enumeration date
09/22/2005
Last updated
01/15/2014
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