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General NPI Number Information
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NPI Number | 1891939575
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Entity Type | Organization
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Legal Business Name | EIDELMAN DERMATOLOGY PLLC
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 245 W 19TH ST GROUND FL
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-675-0549
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Fax | 212-675-0540
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Provider Business Mailing Address
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Address Line | 245 W 19TH ST GROUND FL
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-675-0549
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Fax | 212-675-0540
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL E EIDELMAN
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Credential | M.D.
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Telephone | 212-675-0549
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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 | 209980
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License Number State | NY
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