Healthcare Provider Details

I. General information

NPI: 1861073108
Provider Name (Legal Business Name): MEI LIN MARGONO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLARA BARTON DR
ALBANY NY
12208-3472
US

IV. Provider business mailing address

2 CLARA BARTON DR
ALBANY NY
12208-3472
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5511
  • Fax:
Mailing address:
  • Phone: 518-262-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number334530
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number334530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: