Provider Demographics
NPI:1518297118
Name:POOLE, DOREEN (MSED)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 SHORE RD
Mailing Address - Street 2:APT. 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1859
Mailing Address - Country:US
Mailing Address - Phone:718-702-7135
Mailing Address - Fax:
Practice Address - Street 1:7101 SHORE RD
Practice Address - Street 2:APT. 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1859
Practice Address - Country:US
Practice Address - Phone:718-702-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707781171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor