Provider Demographics
NPI:1154491561
Name:DERMATOLOGY CONSULTANTS LLC
Entity Type:Organization
Organization Name:DERMATOLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBEJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-701-0070
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1853
Mailing Address - Country:US
Mailing Address - Phone:315-701-0070
Mailing Address - Fax:315-701-0075
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:STE 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1853
Practice Address - Country:US
Practice Address - Phone:315-701-0070
Practice Address - Fax:315-701-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty