Provider Demographics
NPI:1225309586
Name:FOREST HILLS DERMATOLOGY GROUP PLLC
Entity Type:Organization
Organization Name:FOREST HILLS DERMATOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-309-3881
Mailing Address - Street 1:200 RIVERSIDE BLVD APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0908
Mailing Address - Country:US
Mailing Address - Phone:718-459-0900
Mailing Address - Fax:718-459-0910
Practice Address - Street 1:8002 KEW GARDENS RD STE 107
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3600
Practice Address - Country:US
Practice Address - Phone:718-459-0900
Practice Address - Fax:718-459-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206843207N00000X
NYN004775213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty