Healthcare Provider Details

I. General information

NPI: 1265174718
Provider Name (Legal Business Name): ELIZABETH ELEANOR DOLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 2
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST # 2
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-7000
  • Fax: 646-697-0029
Mailing address:
  • Phone: 212-746-7000
  • Fax: 646-697-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number345877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: