Provider Demographics
NPI:1528289147
Name:DWORKIN, JANICE M (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:DWORKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MOHAWK LANE
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4614
Mailing Address - Country:US
Mailing Address - Phone:732-446-5299
Mailing Address - Fax:
Practice Address - Street 1:16 EAST 79 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0150
Practice Address - Country:US
Practice Address - Phone:212-249-6122
Practice Address - Fax:212-249-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161581207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63540Medicare UPIN
NY63D342Medicare ID - Type Unspecified