Healthcare Provider Details

I. General information

NPI: 1043212475
Provider Name (Legal Business Name): MARIE THERESE DORCELY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MONTROSE AVE
BROOKLYN NY
11206-2707
US

IV. Provider business mailing address

29 WOODLAND RD
ROSLYN NY
11576-1435
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-1764
  • Fax: 718-381-6652
Mailing address:
  • Phone: 516-365-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number130687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: