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General NPI Number Information
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NPI Number | 1639377690
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES P.C.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 09/08/2007
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Provider Practice Location Address
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Address Line | 1 LONG WHARF DR # 30
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City | NEW HAVEN
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State | CT
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Zip | 06511-5991
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Country | US
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Telephone | 203-787-4171
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LONG WHARF DR 30
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City | NEW HAVEN
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State | CT
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Zip | 06511-5991
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Country | US
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Telephone | 203-787-4171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | MARK JEFFREY GOLDSTEIN
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Credential | M.D.
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Telephone | 203-787-4171
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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 | 025369
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License Number State | CT
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