Provider Demographics
NPI:1326424417
Name:MOULTON-LEVY DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:MOULTON-LEVY DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTON-LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-287-0734
Mailing Address - Street 1:100 JAY ST
Mailing Address - Street 2:27F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 JAY ST
Practice Address - Street 2:27F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1546
Practice Address - Country:US
Practice Address - Phone:646-287-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248077261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty