Provider Demographics
NPI:1407038938
Name:MARILYN VON DOLLEN NP IN PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MARILYN VON DOLLEN NP IN PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER IN PSYCHIATRY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VON DOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS,NPP
Authorized Official - Phone:518-453-2280
Mailing Address - Street 1:1471 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3512
Mailing Address - Country:US
Mailing Address - Phone:518-453-2280
Mailing Address - Fax:518-453-2282
Practice Address - Street 1:1471 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3512
Practice Address - Country:US
Practice Address - Phone:518-453-2280
Practice Address - Fax:518-453-2282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARILYN VON DOLLEN NPP,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400457-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS73022Medicare PIN