Provider Demographics
NPI:1831307958
Name:O'TOOLE, DOREEN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ANN
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK CIR N
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4325
Mailing Address - Country:US
Mailing Address - Phone:631-249-6113
Mailing Address - Fax:
Practice Address - Street 1:6 PARK CIR N
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4325
Practice Address - Country:US
Practice Address - Phone:631-249-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299914-1163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01803589Medicaid