Provider Demographics
NPI:1285231506
Name:CENTURY DERMATOLOGY PC
Entity Type:Organization
Organization Name:CENTURY DERMATOLOGY PC
Other - Org Name:POLLACK DERMATOLOGY PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-820-6091
Mailing Address - Street 1:5604 7TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4660
Mailing Address - Country:US
Mailing Address - Phone:718-450-8918
Mailing Address - Fax:718-450-8919
Practice Address - Street 1:5604 7TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4660
Practice Address - Country:US
Practice Address - Phone:718-450-8918
Practice Address - Fax:718-450-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01890808Medicaid