Provider Demographics
NPI:1013175165
Name:MICHAEL PALTIEL MD PC
Entity Type:Organization
Organization Name:MICHAEL PALTIEL MD PC
Other - Org Name:ADULT AND PEDIATRIC DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-526-8498
Mailing Address - Street 1:10845 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1419
Mailing Address - Country:US
Mailing Address - Phone:917-526-8498
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4309
Practice Address - Country:US
Practice Address - Phone:516-829-3376
Practice Address - Fax:516-829-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245541261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty