MEDICARE: GARDEN CITY DERMATOLOGY, PC

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	207ND0900X	Dermatopathology Physician

General Provider Information

NPI Number	:	1881653194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN CITY DERMATOLOGY, PC

Provider Business Mailing Address
First Line	:	877 STEWART AVE
Second Line	:	SUITE 29
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4803
Country	:	US
Telephone Number	:	516-227-3376
Fax Number	:	516-227-3378

Provider Business Practice Location Address
First Line	:	877 STEWART AVE
Second Line	:	SUITE 29
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4803
Country	:	US
Telephone Number	:	516-227-3376
Fax Number	:	516-227-3378

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THEODORE J DALY
Credential	:	M.D.
Telephone Number	:	516-227-3376

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/22/2020

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