Provider Demographics
NPI:1730601071
Name:DOROFEYCHUK, MICHAEL JOSEPH
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DOROFEYCHUK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:DOROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:317 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3764
Mailing Address - Country:US
Mailing Address - Phone:856-381-2010
Mailing Address - Fax:
Practice Address - Street 1:57 E KINGS HWY
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1216
Practice Address - Country:US
Practice Address - Phone:856-354-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist