Healthcare Provider Details

I. General information

NPI: 1528823507
Provider Name (Legal Business Name): DERM SPECS OF PA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FRONT ST
NEW YORK NY
10038-2033
US

IV. Provider business mailing address

1027 46TH AVE
LONG ISLAND CITY NY
11101-5245
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 212-385-3700
  • 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: MS. DEANN JONES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 212-385-3700