Healthcare Provider Details

I. General information

NPI: 1033040720
Provider Name (Legal Business Name): HIGH LINE DERMATOLOGY SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W 28TH ST
NEW YORK NY
10001-5509
US

IV. Provider business mailing address

514 W 28TH ST
NEW YORK NY
10001-5509
US

V. Phone/Fax

Practice location:
  • Phone: 646-580-4460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HANA JEON
Title or Position: MD
Credential:
Phone: 646-580-4460