Provider Demographics
NPI:1578879763
Name:SONDERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:SONDERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYUNGAH
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-3800
Mailing Address - Street 1:164-10 NORTHERN BLVD.
Mailing Address - Street 2:STE 213
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:201-944-3800
Mailing Address - Fax:
Practice Address - Street 1:16410 NORTHERN BLVD
Practice Address - Street 2:STE. 213
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2677
Practice Address - Country:US
Practice Address - Phone:201-944-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2558341207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty