Provider Demographics
NPI:1467882332
Name:KLEYDMAN DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:KLEYDMAN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-388-0537
Mailing Address - Street 1:2960 OCEAN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3202
Mailing Address - Country:US
Mailing Address - Phone:646-388-0537
Mailing Address - Fax:
Practice Address - Street 1:2960 OCEAN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3202
Practice Address - Country:US
Practice Address - Phone:646-388-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254386207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty