Provider Demographics
NPI:1689268898
Name:GEFFKEN, DOROTHY LEIGH
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LEIGH
Last Name:GEFFKEN
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 1:16 MAIN ST APT D5
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1958
Mailing Address - Country:US
Mailing Address - Phone:973-600-5487
Mailing Address - Fax:
Practice Address - Street 1:14 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-600-5487
Practice Address - Fax:973-957-3222
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01460800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health