Provider Demographics
NPI:1861649519
Name:MUDGIL DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:MUDGIL DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADARSH
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:MUDGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-334-7786
Mailing Address - Street 1:30 5TH AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8803
Mailing Address - Country:US
Mailing Address - Phone:212-228-2526
Mailing Address - Fax:212-228-2735
Practice Address - Street 1:30 5TH AVE APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8803
Practice Address - Country:US
Practice Address - Phone:212-228-2526
Practice Address - Fax:212-228-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233790207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000354Medicare PIN