Provider Demographics
NPI:1609018985
Name:MARY RUTH BUCHNESS MD DERMATOLOGIST PC
Entity Type:Organization
Organization Name:MARY RUTH BUCHNESS MD DERMATOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-822-3515
Mailing Address - Street 1:560 BROADWAY
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3938
Mailing Address - Country:US
Mailing Address - Phone:212-822-3515
Mailing Address - Fax:888-317-8328
Practice Address - Street 1:560 BROADWAY
Practice Address - Street 2:SUITE 406
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3938
Practice Address - Country:US
Practice Address - Phone:212-822-3515
Practice Address - Fax:888-317-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156839207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty