MEDICARE: CECIL A DOLLISON

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	363A00000X	Physician Assistant	006648	NY

General Provider Information

NPI Number	:	1043530769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECIL A DOLLISON

Provider Business Mailing Address
First Line	:	1349 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	718-975-2270
Fax Number	:	718-975-2271

Provider Business Practice Location Address
First Line	:	1349 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	718-975-2270
Fax Number	:	718-975-2271

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	09/19/2014

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Directions to “ CECIL A DOLLISON ” Practice Location

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