Healthcare Provider Details

I. General information

NPI: 1972512754
Provider Name (Legal Business Name): KEITH F DOCKERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FRANKLIN TPKE
WALDWICK NJ
07463-1749
US

IV. Provider business mailing address

318 MEADOWBROOK RD
WYCKOFF NJ
07481-3438
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-8822
  • Fax: 201-815-2078
Mailing address:
  • Phone: 201-485-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number244698
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA09089800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number25MA09089800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: