Provider Demographics
NPI:1104804855
Name:STATFELD, DOV (MD)
Entity type:Individual
Prefix:
First Name:DOV
Middle Name:
Last Name:STATFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3620
Mailing Address - Country:US
Mailing Address - Phone:516-431-1852
Mailing Address - Fax:516-889-0357
Practice Address - Street 1:370 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3620
Practice Address - Country:US
Practice Address - Phone:516-431-1852
Practice Address - Fax:516-889-0357
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01141877Medicaid
E17631Medicare UPIN
NY01141877Medicaid