Basic Information
| Provider Information | |||||||||
| NPI: | 1164432407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DORFNER FAMILY MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 SUNSET RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080163645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093879242 | ||||||||
| FaxNumber: | 6093879408 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 SUNSET RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080163645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093879242 | ||||||||
| FaxNumber: | 6093879408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | NICOLO | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6093879242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MB53910 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8367108 | 05 | NJ | MEDICAID |