MEDICARE: DORFNER FAMILY MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MB53910	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164432407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORFNER FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	811 SUNSET RD
Second Line	:	SUITE 101
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-3645
Country	:	US
Telephone Number	:	609-387-9242
Fax Number	:	609-387-9408

Provider Business Practice Location Address
First Line	:	811 SUNSET RD
Second Line	:	SUITE 101
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-3645
Country	:	US
Telephone Number	:	609-387-9242
Fax Number	:	609-387-9408

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOYCE NICOLO
Credential	:
Telephone Number	:	609-387-9242

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/14/2012

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