Provider Demographics
NPI:1164698064
Name:DORF, RICHARD BRIAN (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRIAN
Last Name:DORF
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4051
Mailing Address - Country:US
Mailing Address - Phone:516-538-4531
Mailing Address - Fax:516-292-6287
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4051
Practice Address - Country:US
Practice Address - Phone:516-538-4531
Practice Address - Fax:516-292-6287
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004919-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant