Healthcare Provider Details

I. General information

NPI: 1851912646
Provider Name (Legal Business Name): KEVIN J DORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST # 139
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 630-201-5549
  • Fax:
Mailing address:
  • Phone: 630-201-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number346940
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: