Organization
C. DICOVSKY MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA LARES (MANAGER)
(973) 278-1000
Entity
Organization
Contact information
Practice address
681 BROADWAY, PATERSON, NJ 07514-1421
(973) 278-1000
(973) 278-1709
Mailing address
681 BROADWAY, PATERSON, NJ 07514-1421
(973) 278-1000
(973) 278-1709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
059094
NJ
207R00000X
Internal Medicine Physician
064703
NJ
207R00000X
Internal Medicine Physician
—
—
2085B0100X
Body Imaging Physician
024361
NJ
Other
Enumeration date
07/20/2005
Last updated
03/10/2022
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