Provider Demographics
NPI:1033818208
Name:AN DERMATOLOGY OF NEW YORK P C
Entity Type:Organization
Organization Name:AN DERMATOLOGY OF NEW YORK P C
Other - Org Name:PREMIER DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NABATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-945-9346
Mailing Address - Street 1:15 THE PNES
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1126
Mailing Address - Country:US
Mailing Address - Phone:516-945-9346
Mailing Address - Fax:231-216-7895
Practice Address - Street 1:110 E 40TH ST RM 703
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1806
Practice Address - Country:US
Practice Address - Phone:516-945-9346
Practice Address - Fax:231-216-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty