MEDICARE: MR. PATRICK JOHN DOOLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F307330-1	NY

General Provider Information

NPI Number	:	1578930798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK JOHN DOOLEY

Provider Business Mailing Address
First Line	:	250 SILLS RD
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8804
Country	:	US
Telephone Number	:	631-289-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 SILLS RD
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8804
Country	:	US
Telephone Number	:	631-289-7474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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Directions to “ MR. PATRICK JOHN DOOLEY ” Practice Location

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