MEDICARE: DR. CHARISSE ALLYN DOLITSKY MD

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	207N00000X	Dermatology Physician	168574-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	070008112	OTHER		PALMETTO GBA RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7903379002	OTHER	CIGNA
2	AE01606	OTHER	MDNY
3	19000	OTHER	MASTERCARE
4	2C8727	OTHER	HEALTHNET
5	31F601	OTHER	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	019530	OTHER	BETTER HEALTH ADVANTAGE
8	124428089	OTHER	TRICARE/CHAMPUS
10	42617	OTHER	VYTRA
11	P397100	OTHER	OXFORD
12	010168574NY01	OTHER	ANTHEM
13	0300191	OTHER	UNITED HEALTHCARE
14	23123	OTHER	GHI
15	69786	OTHER	UHC EMPIRE PLAN
16	73594	OTHER	GHI HMO
17	AETNA/USHEALTHCARE	OTHER	112380

General Provider Information

NPI Number	:	1477510576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARISSE ALLYN DOLITSKY MD

Provider Business Mailing Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-889-5681

Provider Business Practice Location Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-889-5681

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/05/2011

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