Provider Demographics
NPI:1336214162
Name:DOVE, ARTHUR RENNER (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:RENNER
Last Name:DOVE
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 1:25 ODONNELL ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2728
Mailing Address - Country:US
Mailing Address - Phone:212-876-8655
Mailing Address - Fax:212-876-4545
Practice Address - Street 1:85 W 118TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1903
Practice Address - Country:US
Practice Address - Phone:212-876-8655
Practice Address - Fax:212-876-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01675290Medicaid
NY193836B58OtherHEALTHFIRST 65
NY65S271OtherBLUE CROSS BLUE SHIELD
NY043703197OtherCAREPLUS
NY043703197OtherTRICARE
NY04370319701Other1199
NY11C0343OtherCOMMUNITY PREMIER PLUS
NY193836OtherHIP HEALTH PLAN OF NY
NY163691OtherELDERPLAN
NY5588651OtherAETNA
NY043703197OtherMETROPLUS
NY1000000108OtherAFFINITY
NY2594026OtherGHI
NY043703197OtherWELLCHOICE
NY051217400625OtherCENTERCARE
NYWELLCAREOther21191
NYP2053741OtherOXFORD
NY1000000108OtherAFFINITY
NY2594026OtherGHI