Provider Demographics
NPI:1770993669
Name:DORMER, ESKETT ORILLA
Entity type:Individual
Prefix:
First Name:ESKETT
Middle Name:ORILLA
Last Name:DORMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 E 89TH ST
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5123
Mailing Address - Country:US
Mailing Address - Phone:347-713-4910
Mailing Address - Fax:347-713-4910
Practice Address - Street 1:1457 E 89TH ST
Practice Address - Street 2:FL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5123
Practice Address - Country:US
Practice Address - Phone:347-713-4910
Practice Address - Fax:347-713-4910
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist