Provider Demographics
NPI:1003349986
Name:BRIDGEVIEW DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:BRIDGEVIEW DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-200-3003
Mailing Address - Street 1:9920 4TH AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8333
Mailing Address - Country:US
Mailing Address - Phone:929-200-3003
Mailing Address - Fax:929-224-0696
Practice Address - Street 1:9920 4TH AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8333
Practice Address - Country:US
Practice Address - Phone:929-200-3003
Practice Address - Fax:929-224-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282042-207ND0101X
NY282042-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty