Provider Demographics
NPI:1164967246
Name:MARGOLIN, LEINANI FERN (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEINANI
Middle Name:FERN
Last Name:MARGOLIN
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LEINANI
Other - Last Name:BOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, PMHNP-BC
Mailing Address - Street 1:7 LOOKOUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2010
Mailing Address - Country:US
Mailing Address - Phone:845-745-0510
Mailing Address - Fax:206-424-8099
Practice Address - Street 1:580 5TH AVE STE 820
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4762
Practice Address - Country:US
Practice Address - Phone:845-584-5900
Practice Address - Fax:845-584-5900
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60862230363LP0808X
NY844096-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1164967246Medicaid