Provider Demographics
NPI:1124015839
Name:DOERBECKER, JAMES (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DOERBECKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1402
Mailing Address - Country:US
Mailing Address - Phone:516-735-4048
Mailing Address - Fax:516-731-1945
Practice Address - Street 1:2991 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1330
Practice Address - Country:US
Practice Address - Phone:516-735-7778
Practice Address - Fax:516-731-1945
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6400416Medicaid
NYQ24121Medicare ID - Type Unspecified
NY6400416Medicaid