MEDICARE: MS. ANNE HANA DOLGIN M.A., L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0814X	Psychoanalysis Psychologist	000743-1	NY

General Provider Information

NPI Number	:	1043362205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE HANA DOLGIN M.A., L.P.

Provider Business Mailing Address
First Line	:	3363 SEDGWICK AVE
Second Line	:	APT. 6D
City	:	BRONX
State	:	NY
Zip	:	10463-6045
Country	:	US
Telephone Number	:	917-509-3256
Fax Number	:	718-796-3566

Provider Business Practice Location Address
First Line	:	241 W 30TH ST
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-2823
Country	:	US
Telephone Number	:	917-509-3256
Fax Number	:	718-796-3566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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