Provider Demographics
NPI:1215017231
Name:DORFMAN, STUART L (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:L
Last Name:DORFMAN
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 1:6199 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1024
Mailing Address - Country:US
Mailing Address - Phone:716-206-0390
Mailing Address - Fax:716-206-0394
Practice Address - Street 1:6199 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1024
Practice Address - Country:US
Practice Address - Phone:716-206-0390
Practice Address - Fax:716-206-0394
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1392932083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139293OtherSTATE LICENSE NUMBER