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General NPI Number Information
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NPI Number | 1285872275
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Entity Type | Organization
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Legal Business Name | ACCREDITED DERMATOLOGY, LASER & COSMETIC SURGERY, P.C.
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 2615 E 16TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-3805
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Country | US
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Telephone | 718-263-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 567 DONALD LN
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City | WOODMERE
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State | NY
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Zip | 11598-1516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAKOV DUDELZAK
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Credential |
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Telephone | 718-263-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 243425
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License Number State | NY
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