Provider Demographics
NPI:1417206459
Name:DOLGIN, BRETT MARSH (DO)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MARSH
Last Name:DOLGIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GREAT NECK RD APT PH15
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3358
Mailing Address - Country:US
Mailing Address - Phone:516-353-7086
Mailing Address - Fax:
Practice Address - Street 1:255 GREAT NECK RD APT PH15
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3358
Practice Address - Country:US
Practice Address - Phone:516-353-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267986207NS0135X
NY60267986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine