=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922304468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUTURE BRIGHT DERMATOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2011
-----------------------------------------------------
Last Update Date | 04/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 CANAL ST 6TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-882-2777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 CANAL ST 6TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-343-7323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDING DERMATOLOGIST
-----------------------------------------------------
Name | DR. ELAINE F. KUNG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-882-2777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 255489
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------