Provider Demographics
NPI:1720279219
Name:BISCHOF, DOREEN GAIL (FNP)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:GAIL
Last Name:BISCHOF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5628
Mailing Address - Country:US
Mailing Address - Phone:845-264-0078
Mailing Address - Fax:
Practice Address - Street 1:29 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2541
Practice Address - Country:US
Practice Address - Phone:845-486-2963
Practice Address - Fax:845-486-3531
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423320-1163W00000X
NYF342330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409067Medicaid