Provider Demographics
NPI:1245414259
Name:NORTH SHORE DERMATOLOGY ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:NORTH SHORE DERMATOLOGY ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALTZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-747-2230
Mailing Address - Street 1:2 HILLSIDE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2392
Mailing Address - Country:US
Mailing Address - Phone:516-747-2230
Mailing Address - Fax:516-747-1087
Practice Address - Street 1:2 HILLSIDE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2392
Practice Address - Country:US
Practice Address - Phone:516-747-2230
Practice Address - Fax:516-747-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31536XWQQ1Medicare PIN
NY45D37XWQQ1Medicare PIN
NY59H51XWQQ1Medicare PIN
NY54099XWQQ1Medicare PIN
NYWXWQQ1Medicare PIN