Healthcare Provider Details

I. General information

NPI: 1932081999
Provider Name (Legal Business Name): MEB DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 WYCKOFF AVE
BROOKLYN NY
11237-6750
US

IV. Provider business mailing address

142 WYCKOFF AVE
BROOKLYN NY
11237-6750
US

V. Phone/Fax

Practice location:
  • Phone: 718-366-1747
  • Fax:
Mailing address:
  • Phone:
  • 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: MS. SONIA RUIZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 347-642-9802