Provider Demographics
NPI:1407921067
Name:DORF, BRYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:DORF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2451
Mailing Address - Country:US
Mailing Address - Phone:201-332-7932
Mailing Address - Fax:203-406-1744
Practice Address - Street 1:1450 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2451
Practice Address - Country:US
Practice Address - Phone:203-327-9321
Practice Address - Fax:203-406-1744
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG71322Medicare UPIN
CT110007643Medicare ID - Type Unspecified