Healthcare Provider Details

I. General information

NPI: 1033818208
Provider Name (Legal Business Name): AN DERMATOLOGY OF NEW YORK P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 40TH ST RM 703
NEW YORK NY
10016-1806
US

IV. Provider business mailing address

15 THE PNES
OLD WESTBURY NY
11568-1126
US

V. Phone/Fax

Practice location:
  • Phone: 516-945-9346
  • Fax: 231-216-7895
Mailing address:
  • Phone: 516-945-9346
  • Fax: 231-216-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM NABATIAN
Title or Position: CEO
Credential: MD
Phone: 516-945-9346