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General NPI Number Information
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NPI Number | 1477650174
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Entity Type | Organization
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Legal Business Name | URBAN DERMATOLOGY PLLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 594 BROADWAY SUITE 310
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City | NEW YORK
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State | NY
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Zip | 10012-3233
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Country | US
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Telephone | 212-219-8012
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Fax | 212-966-5099
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Provider Business Mailing Address
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Address Line | 594 BROADWAY SUITE 310
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City | NEW YORK
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State | NY
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Zip | 10012-3233
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Country | US
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Telephone | 212-219-8012
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Fax | 212-966-5099
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ELIZABETH GOLDBERG
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Credential | MD
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Telephone | 212-219-8012
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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 | 218795
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License Number State | NY
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