Provider Demographics
NPI:1497838775
Name:ROYE, DORIAN EVADNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:EVADNE
Last Name:ROYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DORIAN
Other - Middle Name:E
Other - Last Name:ROYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1520 YORK AVE
Mailing Address - Street 2:APT 11 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7008
Mailing Address - Country:US
Mailing Address - Phone:212-249-7472
Mailing Address - Fax:
Practice Address - Street 1:100 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2005
Practice Address - Country:US
Practice Address - Phone:718-260-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121778208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8017Medicare UPIN