Provider Demographics
NPI:1629736509
Name:DERMATOLOGY & MOHS SURGERY OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY & MOHS SURGERY OF LONG ISLAND, PLLC
Other - Org Name:NORTH POINT DERMATOLOGY & MOHS SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-846-3300
Mailing Address - Street 1:1000 NORTHERN BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-846-3300
Mailing Address - Fax:516-846-3305
Practice Address - Street 1:1000 NORTHERN BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-808-4098
Practice Address - Fax:888-351-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty