Provider Demographics
NPI:1811385933
Name:WASHINGTON SQUARE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:WASHINGTON SQUARE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-256-1075
Mailing Address - Street 1:2 5TH AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8856
Mailing Address - Country:US
Mailing Address - Phone:212-256-1075
Mailing Address - Fax:
Practice Address - Street 1:2 5TH AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8856
Practice Address - Country:US
Practice Address - Phone:212-256-1075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256936207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty