Provider Demographics
NPI:1609991405
Name:DERMATOLOGY & SURGERY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:DERMATOLOGY & SURGERY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-792-4700
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:3620 E TREMONT AVENUE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-792-4700
Mailing Address - Fax:718-828-1898
Practice Address - Street 1:3620 E TREMONT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2038
Practice Address - Country:US
Practice Address - Phone:718-792-4700
Practice Address - Fax:718-828-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW7F611Medicare ID - Type UnspecifiedGROUP