Provider Demographics
NPI:1265422679
Name:COMMUNITY MEDICAL &DERMATOLOGY CENTER
Entity type:Organization
Organization Name:COMMUNITY MEDICAL &DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-262-2500
Mailing Address - Street 1:291 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5601
Mailing Address - Country:US
Mailing Address - Phone:718-742-6014
Mailing Address - Fax:212-246-0890
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:SUITE 107
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1436
Practice Address - Country:US
Practice Address - Phone:212-262-2500
Practice Address - Fax:212-246-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02370854Medicaid
NYWBW911Medicare ID - Type Unspecified