Provider Demographics
NPI:1609846138
Name:DORFMAN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DORFMAN
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 1:201 E SUNRISE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2529
Mailing Address - Country:US
Mailing Address - Phone:631-225-7200
Mailing Address - Fax:631-225-4565
Practice Address - Street 1:201 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2529
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-225-4565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1772652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01341157Medicaid
NYE83933Medicare UPIN
NY39F921Medicare ID - Type Unspecified