Healthcare Provider Details

I. General information

NPI: 1639495732
Provider Name (Legal Business Name): MANHATTAN DERMATOLOGY AND COSMETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 2ND AVE SUITE 3A
NEW YORK NY
10017
US

IV. Provider business mailing address

820 2ND AVE RM 3A
NEW YORK NY
10017-4534
US

V. Phone/Fax

Practice location:
  • Phone: 212-661-3376
  • Fax: 212-661-3366
Mailing address:
  • Phone: 212-661-3376
  • Fax: 212-661-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number222859
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number222859
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number222859
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number222859
License Number StateNY

VIII. Authorized Official

Name: DR. SNEHAL P AMIN
Title or Position: MEMBER/MANAGER
Credential: M.D.
Phone: 212-661-3376