Provider Demographics
NPI:1851555122
Name:NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Entity Type:Organization
Organization Name:NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-661-3376
Mailing Address - Street 1:353 VETERANS MEMORIAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4200
Mailing Address - Country:US
Mailing Address - Phone:631-543-4888
Mailing Address - Fax:631-543-3549
Practice Address - Street 1:353 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-543-4888
Practice Address - Fax:631-543-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205536-1207N00000X, 207ND0101X, 207NP0225X, 207NS0135X
NY222859207N00000X, 207ND0101X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty