Provider Demographics
NPI:1184820219
Name:DOLAN, STEPHEN JONATHAN (RCPT, RPFT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JONATHAN
Last Name:DOLAN
Suffix:
Gender:M
Credentials:RCPT, RPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LANDAU AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3600
Mailing Address - Country:US
Mailing Address - Phone:516-361-0113
Mailing Address - Fax:516-358-7159
Practice Address - Street 1:111 LANDAU AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3600
Practice Address - Country:US
Practice Address - Phone:516-361-0113
Practice Address - Fax:516-358-7159
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000508247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other