Healthcare Provider Details

I. General information

NPI: 1700781093
Provider Name (Legal Business Name): DERMATOLOGY HOUSE OF NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SQUADRON BLVD STE 102
NEW CITY NY
10956-5232
US

IV. Provider business mailing address

612 CORPORATE WAY STE 2M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 718-362-1411
  • Fax: 718-362-1651
Mailing address:
  • Phone: 877-258-6331
  • Fax: 718-362-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH CHANDLER HUGHES
Title or Position: OWNER
Credential: MD
Phone: 206-225-4731