Provider Demographics
NPI:1972512754
Name:DOCKERY, KEITH F (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:F
Last Name:DOCKERY
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 1:318 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3438
Mailing Address - Country:US
Mailing Address - Phone:201-485-7893
Mailing Address - Fax:
Practice Address - Street 1:20 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1749
Practice Address - Country:US
Practice Address - Phone:201-445-8822
Practice Address - Fax:201-815-2078
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2446982085R0202X
NJ25MA090898002085R0202X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0297453Medicaid
NJ0297453Medicaid
NYRB6008Medicare PIN
NJ241951A4HMedicare PIN