Provider Demographics
NPI:1629040803
Name:DORMAN, ROBERT I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:DORMAN
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 1:60 DUTCH HILL RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1723
Mailing Address - Country:US
Mailing Address - Phone:845-359-4770
Mailing Address - Fax:845-359-0017
Practice Address - Street 1:60 DUTCH HILL RD
Practice Address - Street 2:SUITE 18
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1723
Practice Address - Country:US
Practice Address - Phone:845-359-4770
Practice Address - Fax:845-359-0017
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007798OtherGHI HMO
11462OtherHUDSON HEALTHPLANS
NY00142732Medicaid
0D2711OtherHEALTHNET
4230342OtherAETNA
693481OtherEMPIRE BLUECROSS BLUESHIELD
070010309OtherRAILROAD MEDICARE
2200230OtherGHI
RS140OtherOXFORD HEALTHPLANS
107798OtherWELLCARE
1046064OtherUNITED HEALTHCARE
0290794OtherCIGNA HEALTHPLANS
RS140OtherOXFORD HEALTHPLANS
NY00142732Medicaid