Healthcare Provider Details

I. General information

NPI: 1134889801
Provider Name (Legal Business Name): NOOR DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 BRONX BLVD
BRONX NY
10466-2670
US

IV. Provider business mailing address

8808 179TH ST
JAMAICA NY
11432-4734
US

V. Phone/Fax

Practice location:
  • Phone: 929-229-2189
  • Fax: 929-223-7740
Mailing address:
  • Phone: 929-229-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAR NOOR
Title or Position: MD
Credential: MD
Phone: 804-937-0766