Provider Demographics
NPI:1255436499
Name:DORF, BARRY S (MD FACG)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:DORF
Suffix:
Gender:M
Credentials:MD FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WEST LINCOLN AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-872-3885
Mailing Address - Fax:516-872-0305
Practice Address - Street 1:20 WEST LINCOLN AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-872-3885
Practice Address - Fax:516-872-0305
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147051207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
17D911Medicare ID - Type Unspecified
B10176Medicare UPIN