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NPI Code Detail

MEDICARE: JOVANTE DEWAYNE DOCKERY DO, MS

MEDICARE: JOVANTE DEWAYNE DOCKERY DO, MS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY

General Provider Information

NPI Number : 1194667923
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOVANTE DEWAYNE DOCKERY DO, MS
Provider Business Mailing Address
First Line : 355 BARD AVE
Second Line : DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
City : STATEN ISLAND
State : NY
Zip : 10310-1699
Country : US
Telephone Number : 718-818-2419
Fax Number :
Provider Business Practice Location Address
First Line : 355 BARD AVE
Second Line : DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
City : STATEN ISLAND
State : NY
Zip : 10310-1699
Country : US
Telephone Number : 718-818-2419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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