Provider Demographics
NPI:1821135609
Name:MID ISLAND DERMATOLOGY
Entity Type:Organization
Organization Name:MID ISLAND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABITTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-295-3838
Mailing Address - Street 1:1122 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1242
Mailing Address - Country:US
Mailing Address - Phone:516-295-3838
Mailing Address - Fax:516-295-4976
Practice Address - Street 1:55 POST AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4361
Practice Address - Country:US
Practice Address - Phone:516-334-6650
Practice Address - Fax:516-334-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW8D981Medicare PIN