Provider Demographics
NPI:1740056415
Name:EAST COAST DERMATOLOGY P.C.
Entity type:Organization
Organization Name:EAST COAST DERMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIADORCHANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-974-7436
Mailing Address - Street 1:2549 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2505
Mailing Address - Country:US
Mailing Address - Phone:718-974-7436
Mailing Address - Fax:
Practice Address - Street 1:2549 E 23RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2505
Practice Address - Country:US
Practice Address - Phone:718-974-7436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty