Provider Demographics
NPI:1700169125
Name:ROSE DERMATOLOGY PC
Entity Type:Organization
Organization Name:ROSE DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLY-ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARASKEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-673-4159
Mailing Address - Street 1:3074 31ST ST
Mailing Address - Street 2:1A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1857
Mailing Address - Country:US
Mailing Address - Phone:718-728-3376
Mailing Address - Fax:
Practice Address - Street 1:3074 31ST ST
Practice Address - Street 2:1A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1857
Practice Address - Country:US
Practice Address - Phone:718-728-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243252207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty