MEDICARE: STEPHANIE DORME

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	174400000X	Specialist	1106183171
2	174400000X	Specialist	1106183171	NY

General Provider Information

NPI Number	:	1932683042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DORME

Provider Business Mailing Address
First Line	:	405 SLEIGHT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1960
Country	:	US
Telephone Number	:	718-864-6983
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 SLEIGHT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1960
Country	:	US
Telephone Number	:	718-864-6983
Fax Number	:

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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Directions to “ STEPHANIE DORME ” Practice Location

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