MEDICARE: ADULT & PEDIATRIC DERMATOLOGY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1164677936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & PEDIATRIC DERMATOLOGY GROUP

Provider Business Mailing Address
First Line	:	7734 113TH ST
Second Line	:	APT. B
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7133
Country	:	US
Telephone Number	:	718-544-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	7734 113TH ST
Second Line	:	APT. B
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7133
Country	:	US
Telephone Number	:	718-544-6650
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STUART ROSS BITTERMAN
Credential	:	M.D.
Telephone Number	:	718-544-6650

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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