Healthcare Provider Details

I. General information

NPI: 1992785117
Provider Name (Legal Business Name): ORBUCH, BRAND DERMATOLOGY ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4277 HEMPSTEAD TPKE SUITE 206
BETHPAGE NY
11714-5709
US

IV. Provider business mailing address

4277 HEMPSTEAD TPKE SUITE 206
BETHPAGE NY
11714-5709
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-6505
  • Fax: 516-735-8746
Mailing address:
  • Phone: 516-731-6505
  • Fax: 516-735-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP ORBUCH
Title or Position: PARTNER
Credential: M.D.
Phone: 516-731-6505