Healthcare Provider Details

I. General information

NPI: 1144142274
Provider Name (Legal Business Name): ASTORIA DERMATOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 31ST ST FL 2
ASTORIA NY
11102-1748
US

IV. Provider business mailing address

2583 31ST ST FL 2
ASTORIA NY
11102-1748
US

V. Phone/Fax

Practice location:
  • Phone: 718-728-9822
  • Fax: 718-728-2004
Mailing address:
  • Phone: 718-728-9822
  • Fax: 718-728-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER NICOLAIDES
Title or Position: OWNER
Credential: MD
Phone: 718-728-9822