Healthcare Provider Details

I. General information

NPI: 1487281069
Provider Name (Legal Business Name): ADEM DUKA I D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1699
US

IV. Provider business mailing address

883 TARGEE ST
STATEN ISLAND NY
10304-4518
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-1234
  • Fax:
Mailing address:
  • Phone: 845-790-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number334369
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: