Healthcare Provider Details

I. General information

NPI: 1831307958
Provider Name (Legal Business Name): DOREEN ANN O'TOOLE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PARK CIR N
FARMINGDALE NY
11735-4325
US

IV. Provider business mailing address

6 PARK CIR N
FARMINGDALE NY
11735-4325
US

V. Phone/Fax

Practice location:
  • Phone: 631-249-6113
  • Fax:
Mailing address:
  • Phone: 631-249-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number299914-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: