Provider Demographics
NPI:1063517902
Name:DOKTOR, JESSIE (DA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:DOKTOR
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 WALL RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-9650
Mailing Address - Country:US
Mailing Address - Phone:413-536-3782
Mailing Address - Fax:
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other