Provider Demographics
NPI:1992215180
Name:NEW SEASON DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:NEW SEASON DERMATOLOGY, PLLC
Other - Org Name:ANEW DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:EGBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSC
Authorized Official - Phone:607-444-5446
Mailing Address - Street 1:302 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1308
Mailing Address - Country:US
Mailing Address - Phone:607-444-5446
Mailing Address - Fax:607-444-5447
Practice Address - Street 1:302 REYNOLDS RD STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1308
Practice Address - Country:US
Practice Address - Phone:607-444-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288727207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty