Provider Demographics
NPI:1043212475
Name:DORCELY, MARIE THERESE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THERESE
Last Name:DORCELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1435
Mailing Address - Country:US
Mailing Address - Phone:516-365-6316
Mailing Address - Fax:
Practice Address - Street 1:210 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2707
Practice Address - Country:US
Practice Address - Phone:718-497-1764
Practice Address - Fax:718-381-6652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine