Healthcare Provider Details

I. General information

NPI: 1225309586
Provider Name (Legal Business Name): FOREST HILLS DERMATOLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 KEW GARDENS RD STE 107
KEW GARDENS NY
11415-3600
US

IV. Provider business mailing address

200 RIVERSIDE BLVD APT 7I
NEW YORK NY
10069-0908
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-0900
  • Fax: 718-459-0910
Mailing address:
  • Phone: 718-459-0900
  • Fax: 718-459-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number206843
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004775
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY M WEINBERG
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 917-309-3881