Provider Demographics
NPI:1689734790
Name:INGLETON DERMATOLOGY P.C.
Entity Type:Organization
Organization Name:INGLETON DERMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:INGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-673-7100
Mailing Address - Street 1:14 E 4TH ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1155
Mailing Address - Country:US
Mailing Address - Phone:212-673-7100
Mailing Address - Fax:212-673-6566
Practice Address - Street 1:14 E 4TH ST
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1155
Practice Address - Country:US
Practice Address - Phone:212-673-7100
Practice Address - Fax:212-673-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEP181Medicare PIN