Healthcare Provider Details

I. General information

NPI: 1285211599
Provider Name (Legal Business Name): GERALD JOHN DOHERTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 QUEENS BLVD STE 501
REGO PARK NY
11374-4503
US

IV. Provider business mailing address

9525 QUEENS BLVD STE 501
REGO PARK NY
11374-4503
US

V. Phone/Fax

Practice location:
  • Phone: 718-460-2300
  • Fax:
Mailing address:
  • Phone: 718-460-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number329130
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number329130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: