Provider Demographics
NPI:1548225493
Name:DOLEN, SULEYMAN ENDER (MD)
Entity Type:Individual
Prefix:
First Name:SULEYMAN
Middle Name:ENDER
Last Name:DOLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARCUS DRIVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-391-7889
Mailing Address - Fax:631-454-4161
Practice Address - Street 1:89-06 135TH STREET
Practice Address - Street 2:SUITE 6S
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-206-6708
Practice Address - Fax:718-206-6706
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132824207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02205690Medicaid
NY0105NJMedicare ID - Type Unspecified
NY02205690Medicaid