Provider Demographics
NPI:1134133671
Name:DOLLEY, KEVIN (NP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:DOLLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BROOKSITE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3400
Mailing Address - Country:US
Mailing Address - Phone:631-724-1331
Mailing Address - Fax:631-360-5646
Practice Address - Street 1:9 BROOKSITE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3400
Practice Address - Country:US
Practice Address - Phone:631-724-1331
Practice Address - Fax:631-360-5646
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333868173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine