Provider Demographics
NPI:1770508079
Name:DEMPSEY, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1190 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4450
Mailing Address - Country:US
Mailing Address - Phone:631-727-1818
Mailing Address - Fax:631-727-7365
Practice Address - Street 1:1190 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4450
Practice Address - Country:US
Practice Address - Phone:631-727-1818
Practice Address - Fax:631-727-7365
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00417029Medicaid
NY319781Medicare ID - Type Unspecified
NY00417029Medicaid