Provider Demographics
NPI:1477510576
Name:DOLITSKY, CHARISSE ALLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:ALLYN
Last Name:DOLITSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2505
Mailing Address - Country:US
Mailing Address - Phone:516-432-0011
Mailing Address - Fax:516-889-5681
Practice Address - Street 1:604 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2505
Practice Address - Country:US
Practice Address - Phone:516-432-0011
Practice Address - Fax:516-889-5681
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168574-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7903379002OtherCIGNA
AE01606OtherMDNY
19000OtherMASTERCARE
2C8727OtherHEALTHNET
31F601OtherBCBS
NY01453456Medicaid
019530OtherBETTER HEALTH ADVANTAGE
124428089OtherTRICARE/CHAMPUS
070008112OtherPALMETTO GBA RR MEDICARE
42617OtherVYTRA
P397100OtherOXFORD
010168574NY01OtherANTHEM
0300191OtherUNITED HEALTHCARE
23123OtherGHI
69786OtherUHC EMPIRE PLAN
73594OtherGHI HMO
AETNA/USHEALTHCAREOther112380
0300191OtherUNITED HEALTHCARE
42617OtherVYTRA