Provider Demographics
NPI:1871665844
Name:DORFMAN, NATAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATAN
Middle Name:
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BROADWAY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3519
Mailing Address - Country:US
Mailing Address - Phone:212-431-4059
Mailing Address - Fax:212-431-4939
Practice Address - Street 1:402 BROADWAY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3519
Practice Address - Country:US
Practice Address - Phone:212-431-4059
Practice Address - Fax:212-431-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02138356Medicaid
NYC58591Medicare PIN