Provider Demographics
NPI:1922274182
Name:ATLANTIC DERMATOLOGIC ASSOCIATES, LLP
Entity Type:Organization
Organization Name:ATLANTIC DERMATOLOGIC ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-599-4242
Mailing Address - Street 1:444 MERRICK RD STE LL2
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2400
Mailing Address - Country:US
Mailing Address - Phone:516-599-4242
Mailing Address - Fax:516-599-4449
Practice Address - Street 1:2270 KIMBALL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5139
Practice Address - Country:US
Practice Address - Phone:718-253-4550
Practice Address - Fax:718-253-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146498-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty