1679694343 NPI number — ACCURATE DERMATOLOGY P.L.L.C.

Table of content: (NPI 1679694343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679694343 NPI number — ACCURATE DERMATOLOGY P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE DERMATOLOGY P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679694343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 E 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-6406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-787-2215
Provider Business Mailing Address Fax Number:
718-787-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-4932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-9730
Provider Business Practice Location Address Fax Number:
516-822-9764
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SETAREH-SHENAS
Authorized Official First Name:
BIJAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-822-9730

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02109566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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