Provider Demographics
NPI:1760752182
Name:DORFMAN, BEN IRVING (EAMP)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:IRVING
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3415
Mailing Address - Country:US
Mailing Address - Phone:301-775-6326
Mailing Address - Fax:
Practice Address - Street 1:657 ALDER ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3415
Practice Address - Country:US
Practice Address - Phone:301-775-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60263618171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist