Organization · NPI-2

Advanced Dermatology Of New York PC

Dermatology · Bronx, NY

NPI number1508048240
StatusActive
Last updated in NPPESDec 10, 2014

Details

NPI
1508048240
Entity type
Organization (NPI-2)
Legal business name
Advanced Dermatology Of New York PC
Organization subpart
No
Enumeration date
Dec 5, 2007
Last updated
Dec 10, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207N00000X Dermatology––Yes

Other names

  • Advanced Dermatology Associates (Doing Business As)

Practice location

291 E 149th St
Bronx, NY 10451-5601

Phone 718-742-1000 · Fax 212-765-3210

Mailing address

200 Central Park S
Suite 107
New York, NY 10019-1436

Phone 212-262-2500 · Fax 212-765-3210

Authorized official

Lawrence D Jaeger
Officer
2122622500

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