Provider Demographics
NPI:1245347079
Name:NEW AGE DERMATOLOGY PLLC
Entity type:Organization
Organization Name:NEW AGE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-616-7117
Mailing Address - Street 1:7812 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2900
Mailing Address - Country:US
Mailing Address - Phone:718-416-4600
Mailing Address - Fax:
Practice Address - Street 1:7812 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2900
Practice Address - Country:US
Practice Address - Phone:718-416-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty