Provider Demographics
NPI:1801827647
Name:DUFFY, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:DUFFY
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 1:2712 BAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1056
Mailing Address - Country:US
Mailing Address - Phone:718-746-0456
Mailing Address - Fax:718-747-6096
Practice Address - Street 1:2710 30TH AVE
Practice Address - Street 2:SUITE LA
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2401
Practice Address - Country:US
Practice Address - Phone:718-932-9870
Practice Address - Fax:718-932-9878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112757-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00204260Medicaid
NYA49325Medicare UPIN
NY00204260Medicaid