Provider Demographics
NPI:1174331649
Name:DOLAN, BRIAN THOMAS (AGPCNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:DOLAN
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 AMORY AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1213
Mailing Address - Country:US
Mailing Address - Phone:845-709-3955
Mailing Address - Fax:
Practice Address - Street 1:353 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5606
Practice Address - Country:US
Practice Address - Phone:347-798-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health