Provider Demographics
NPI:1609835065
Name:SILFEN, DOUGLAS WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:SILFEN
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 1:224 SECATOGUE LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4727
Mailing Address - Country:US
Mailing Address - Phone:631-988-5404
Mailing Address - Fax:
Practice Address - Street 1:224 SECATOGUE LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4727
Practice Address - Country:US
Practice Address - Phone:631-988-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1951172085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01920158Medicaid
NY601S61Medicare ID - Type Unspecified
NY01920158Medicaid