Provider Demographics
NPI:1598963217
Name:DERMATOLOGY&AESTHETICS P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY&AESTHETICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-541-0593
Mailing Address - Street 1:8519 65TH RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5035
Mailing Address - Country:US
Mailing Address - Phone:718-541-0593
Mailing Address - Fax:
Practice Address - Street 1:6321 ALDERTON ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2824
Practice Address - Country:US
Practice Address - Phone:718-651-7302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty