MEDICARE: MR. ROBERT DORSKY DMD

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	1223G0001X	General Practice Dentistry	22DD01434400	NJ

General Provider Information

NPI Number	:	1184612277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DORSKY DMD

Provider Business Mailing Address
First Line	:	2400 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3610
Country	:	US
Telephone Number	:	201-867-0900
Fax Number	:	201-867-2352

Provider Business Practice Location Address
First Line	:	2400 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3610
Country	:	US
Telephone Number	:	201-867-0900
Fax Number	:	201-867-2352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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