Healthcare Provider Details

I. General information

NPI: 1306012737
Provider Name (Legal Business Name): ATLANTIC DERMATOLOGIC ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MERRICK RD STE LL2
LYNBROOK NY
11563-2400
US

IV. Provider business mailing address

444 MERRICK RD STE LL2
LYNBROOK NY
11563-2400
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-4498
  • Fax: 516-599-4449
Mailing address:
  • Phone: 516-599-4498
  • Fax: 516-599-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1464981
License Number StateNY

VIII. Authorized Official

Name: DR. MARVIN BRIAN TANKEL
Title or Position: PARTNER
Credential: MD
Phone: 516-599-4242