Organization · NPI-2

1091 Southern Blvd Dermatology PLLC

Dermatology · Bronx, NY

NPI number1154004133
StatusActive
Last updated in NPPESAug 8, 2023

Details

NPI
1154004133
Entity type
Organization (NPI-2)
Legal business name
1091 Southern Blvd Dermatology PLLC
Organization subpart
No
Enumeration date
Aug 8, 2023
Certification date
Aug 8, 2023
Last updated
Aug 8, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207N00000X Dermatology––Yes

Practice location

1091 Southern Blvd
Bronx, NY 10459-2417

Phone 718-401-7000 · Fax 917-473-7878

Mailing address

4037 74th St
Elmhurst, NY 11373-5603

Phone 347-642-9802 · Fax 347-642-9852

Authorized official

Wendy Sanchez
Office Manager
3476429802

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