Provider Demographics
NPI:1346210820
Name:DORNFELD, DAVID BRUCE (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:DORNFELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 STATE HWY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748
Mailing Address - Country:US
Mailing Address - Phone:732-671-3730
Mailing Address - Fax:732-706-1078
Practice Address - Street 1:1680 HWY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1832
Practice Address - Country:US
Practice Address - Phone:732-671-3730
Practice Address - Fax:732-706-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04895800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5112109Medicaid
NJ574145Medicare ID - Type Unspecified
E27326Medicare UPIN