Provider Demographics
NPI:1790210516
Name:BB MEDICAL AND DERMATOLOGY INC
Entity Type:Organization
Organization Name:BB MEDICAL AND DERMATOLOGY INC
Other - Org Name:BB MEDICAL AND DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-802-1310
Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:415-802-1310
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:415-802-1310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273364-1207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid