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General NPI Number Information
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NPI Number | 1518766831
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Entity Type | Organization
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Legal Business Name | CENTURY MEDICAL DERMATOLOGY PLLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 4146 MAIN ST # 2A
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City | FLUSHING
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State | NY
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Zip | 11355-3183
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Country | US
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Telephone | 718-360-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 5604 7TH AVE STE 1
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City | BROOKLYN
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State | NY
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Zip | 11220-4660
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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 | SOLE OWNER/MEMBER
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Name | ELENA POLLACK
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Credential | MD
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Telephone | 212-971-1336
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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 |
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License Number State |
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