Healthcare Provider Details

I. General information

NPI: 1700434362
Provider Name (Legal Business Name): CONNOR A DOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STEWART AVE STE 140
GARDEN CITY NY
11530-4757
US

IV. Provider business mailing address

95 SOMERSET AVE
GARDEN CITY NY
11530-1112
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-4015
  • Fax:
Mailing address:
  • Phone: 516-220-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: