Healthcare Provider Details

I. General information

NPI: 1023063906
Provider Name (Legal Business Name): EAST SIDE DERMATOLOGY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date: 06/24/2025
Reactivation Date: 07/17/2025

III. Provider practice location address

317 EAST 34TH STREET 11 FLOOR
NEW YORK NY
10016-4996
US

IV. Provider business mailing address

PO BOX 24904
NEW YORK NY
10087-4904
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7306
  • Fax: 212-686-7305
Mailing address:
  • Phone: 212-686-7306
  • Fax: 212-686-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROY S SEIDENBERG
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 212-686-7306