Healthcare Provider Details

I. General information

NPI: 1134236722
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF HUNTINGTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 MAIN ST SUITE #105
HUNTINGTON NY
11743-6917
US

IV. Provider business mailing address

177 MAIN ST
HUNTINGTON NY
11743-6917
US

V. Phone/Fax

Practice location:
  • Phone: 631-421-4188
  • Fax: 631-421-4197
Mailing address:
  • Phone: 631-421-4188
  • Fax: 631-421-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN TIMONEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-421-4188