Provider Demographics
NPI:1609885425
Name:DERMATOLOGY GROUP, PC
Entity Type:Organization
Organization Name:DERMATOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKROKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-666-0500
Mailing Address - Street 1:332 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8404
Mailing Address - Country:US
Mailing Address - Phone:631-666-0500
Mailing Address - Fax:631-666-0503
Practice Address - Street 1:332 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8404
Practice Address - Country:US
Practice Address - Phone:631-666-0500
Practice Address - Fax:631-666-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW07511Medicare ID - Type Unspecified