Provider Demographics
NPI:1851476170
Name:DOGOT, MARIANNA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:DOGOT
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 1:6A OSBORNE LN
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1141
Mailing Address - Country:US
Mailing Address - Phone:516-484-6411
Mailing Address - Fax:516-484-6649
Practice Address - Street 1:15 GLEN ST STE 304
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2786
Practice Address - Country:US
Practice Address - Phone:516-759-3742
Practice Address - Fax:516-484-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2071362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883343Medicaid
NY02970AMedicare ID - Type Unspecified
NY01883343Medicaid