Samuel Emmanuel Dickerson, lpn
Licensed Practical Nurse in Roosevelt, NY. Individual provider (NPI-1).
NPI number1902139447
StatusActive
Last updated in NPPESSep 16, 2009
Details
- NPI
- 1902139447
- Entity type
- Individual (NPI-1)
- Name
- Mr. Samuel Emmanuel Dickerson
- Credential
- lpn
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 16, 2009
- Last updated
- Sep 16, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 241150-1 | NY | Yes |
Practice location
95 W Greenwich AveRoosevelt, NY 11575-1035
Phone 516-481-3421 · Fax 516-665-3798
Mailing address
95 W Greenwich AveRoosevelt, NY 11575-1035
Phone 516-481-3421 · Fax 516-665-3798
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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