Provider Demographics
NPI:1164432407
Name:DORFNER FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:DORFNER FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-387-9242
Mailing Address - Street 1:811 SUNSET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3645
Mailing Address - Country:US
Mailing Address - Phone:609-387-9242
Mailing Address - Fax:609-387-9408
Practice Address - Street 1:811 SUNSET RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3645
Practice Address - Country:US
Practice Address - Phone:609-387-9242
Practice Address - Fax:609-387-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB53910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8367108Medicaid
NJ8367108Medicaid