Healthcare Provider Details

I. General information

NPI: 1447264387
Provider Name (Legal Business Name): ATLANTIC DERMATOLOGIC ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
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: 516-599-4242
  • 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 Number146498-1
License Number StateNY

VIII. Authorized Official

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