Healthcare Provider Details

I. General information

NPI: 1194016212
Provider Name (Legal Business Name): BRIAN GINSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

245 W. 19TH ST.
NEW YORK NY
10011
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone: 212-675-0549
  • Fax: 212-675-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number266979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: