Provider Demographics
NPI:1083773766
Name:DOLBER, ALAN IRA
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:IRA
Last Name:DOLBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25O WEST 57 ST.
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 WEST 57 ST.
Practice Address - Street 2:SUITE 501
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10019-5014
Practice Address - Country:US
Practice Address - Phone:212-679-6906
Practice Address - Fax:212-586-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR009132-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN29351Medicare ID - Type Unspecified