Provider Demographics
NPI:1861622615
Name:DILLING, MARYLEE H (MD)
Entity type:Individual
Prefix:DR
First Name:MARYLEE
Middle Name:H
Last Name:DILLING
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 1:920 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0208
Mailing Address - Country:US
Mailing Address - Phone:212-390-9294
Mailing Address - Fax:888-718-5854
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0208
Practice Address - Country:US
Practice Address - Phone:212-390-9294
Practice Address - Fax:888-718-5854
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269548208000000X, 207R00000X, 208000000X, 207R00000X
CT52488207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid