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General NPI Number Information
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NPI Number | 1770529133
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Entity Type | Organization
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Legal Business Name | SCARSDALE DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1075 CENTRAL PARK AVE SUITE 304
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City | SCARSDALE
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State | NY
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Zip | 10583-3242
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Country | US
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Telephone | 914-722-1800
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Fax | 914-722-2109
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Provider Business Mailing Address
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Address Line | 1075 CENTRAL PARK AVE SUITE 304
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City | SCARSDALE
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State | NY
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Zip | 10583-3242
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Country | US
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Telephone | 914-722-1800
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Fax | 914-722-2109
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL B BRODIN
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Credential | M.D.
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Telephone | 914-722-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1421231
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License Number State | NY
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