Provider Demographics
NPI:1639408818
Name:SPRING STREET DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:SPRING STREET DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-431-4749
Mailing Address - Street 1:73 SPRING ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-5800
Mailing Address - Country:US
Mailing Address - Phone:212-431-4749
Mailing Address - Fax:
Practice Address - Street 1:73 SPRING ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5800
Practice Address - Country:US
Practice Address - Phone:212-431-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty