Healthcare Provider Details

I. General information

NPI: 1164698064
Provider Name (Legal Business Name): RICHARD BRIAN DORF RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAIN ST
HEMPSTEAD NY
11550-4051
US

IV. Provider business mailing address

54 MAIN ST
HEMPSTEAD NY
11550-4051
US

V. Phone/Fax

Practice location:
  • Phone: 516-538-4531
  • Fax: 516-292-6287
Mailing address:
  • Phone: 516-538-4531
  • Fax: 516-292-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004919-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: