Provider Demographics
NPI:1275775991
Name:DORFMAN, RANDY C (MA CCC-SLP, BRS-FD)
Entity Type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:C
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP, BRS-FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALGONQUIN CIR
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5231
Mailing Address - Country:US
Mailing Address - Phone:845-426-6595
Mailing Address - Fax:845-578-1502
Practice Address - Street 1:15 ALGONQUIN CIR
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-5231
Practice Address - Country:US
Practice Address - Phone:845-426-6595
Practice Address - Fax:845-578-1502
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006965-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist