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General NPI Number Information
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NPI Number | 1538566070
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Entity Type | Organization
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Legal Business Name | COMPLETE DERMATOLOGY AND SKIN CARE PLLC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 225 BROADWAY SUITE 1610
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City | NEW YORK
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State | NY
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Zip | 10007-3001
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Country | US
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Telephone | 212-225-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 225 BROADWAY SUITE 1610
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City | NEW YORK
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State | NY
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Zip | 10007-3001
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Country | US
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Telephone | 212-225-8444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEJAL SHAH
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Credential | M.D.
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Telephone | 212-225-8444
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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 | 243008
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License Number State | NY
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