Healthcare Provider Details

I. General information

NPI: 1417142910
Provider Name (Legal Business Name): DOLORES DUFFY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 09/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 VALERIA CIR
NORTH SALEM NY
10560-3709
US

IV. Provider business mailing address

36 OLCOTT AVE
CROTON ON HUDSON NY
10520-2725
US

V. Phone/Fax

Practice location:
  • Phone: 914-301-5067
  • Fax:
Mailing address:
  • Phone: 914-862-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number286510-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: