Provider Demographics
NPI:1619319225
Name:O DRISCOLL, DEARBHAIL
Entity Type:Individual
Prefix:
First Name:DEARBHAIL
Middle Name:
Last Name:O DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 76TH ST
Mailing Address - Street 2:APT 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2510
Mailing Address - Country:US
Mailing Address - Phone:917-741-6067
Mailing Address - Fax:
Practice Address - Street 1:425 E 76TH ST
Practice Address - Street 2:APT 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2510
Practice Address - Country:US
Practice Address - Phone:917-741-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP895622085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging