Provider Demographics
NPI:1700341617
Name:DB DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:DB DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANUSALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-970-9100
Mailing Address - Street 1:483 10TH AVENUE, SUITE 310
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9737
Mailing Address - Country:US
Mailing Address - Phone:917-970-9100
Mailing Address - Fax:
Practice Address - Street 1:483 10TH AVENUE, SUITE 310
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9737
Practice Address - Country:US
Practice Address - Phone:917-970-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty