Provider Demographics
NPI:1114954005
Name:ALTMANN, DORY BERT (MD)
Entity Type:Individual
Prefix:
First Name:DORY
Middle Name:BERT
Last Name:ALTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 CRANBURY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-3333
Mailing Address - Fax:732-390-9244
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-390-3333
Practice Address - Fax:732-390-9244
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06545100207RI0011X, 207R00000X
NJMA06545100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57791Medicare UPIN
NJ002384Medicare PIN
NJ002384YKYAMedicare PIN