1518185727 NPI number — WEST 57TH STREET DERMATOLOGY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518185727 NPI number — WEST 57TH STREET DERMATOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST 57TH STREET DERMATOLOGY PLLC
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:
6
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:
1518185727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 HARWOOD CT
Provider Second Line Business Mailing Address:
STE 217
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583-4121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-472-4100
Provider Business Mailing Address Fax Number:
914-472-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 HARWOOD CT
Provider Second Line Business Practice Location Address:
STE 217
Provider Business Practice Location Address City Name:
SCARSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10583-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-472-4100
Provider Business Practice Location Address Fax Number:
914-472-4105
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRIEGEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
914-472-4100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  186813 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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