Provider Demographics
NPI:1659556777
Name:VANGUARD DERMATOLOGY
Entity Type:Organization
Organization Name:VANGUARD DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-609-0310
Mailing Address - Street 1:698 MANHATTAN AVE
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3160
Mailing Address - Country:US
Mailing Address - Phone:718-609-0310
Mailing Address - Fax:718-332-3454
Practice Address - Street 1:2119 E 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4314
Practice Address - Country:US
Practice Address - Phone:718-332-2999
Practice Address - Fax:718-332-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCW671Medicare PIN