MEDICARE: SCARSDALE DERMATOLOGY, P.C.

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	174400000X	Specialist	1421231	NY

General Provider Information

NPI Number	:	1770529133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARSDALE DERMATOLOGY, P.C.

Provider Business Mailing Address
First Line	:	1075 CENTRAL PARK AVE
Second Line	:	SUITE 304
City	:	SCARSDALE
State	:	NY
Zip	:	10583-3242
Country	:	US
Telephone Number	:	914-722-1800
Fax Number	:	914-722-2109

Provider Business Practice Location Address
First Line	:	1075 CENTRAL PARK AVE
Second Line	:	SUITE 304
City	:	SCARSDALE
State	:	NY
Zip	:	10583-3242
Country	:	US
Telephone Number	:	914-722-1800
Fax Number	:	914-722-2109

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL B BRODIN
Credential	:	M.D.
Telephone Number	:	914-722-1800

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/22/2020

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