MEDICARE: NATNAELLE ERMYAS ADMASSU MD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	339838	NY

General Provider Information

NPI Number	:	1154909000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATNAELLE ERMYAS ADMASSU MD, MS

Provider Business Mailing Address
First Line	:	262 W 53RD ST FL 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-5807
Country	:	US
Telephone Number	:	212-641-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 W 53RD ST FL 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-5807
Country	:	US
Telephone Number	:	212-641-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	11/11/2025

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