Provider Demographics
NPI:1063717338
Name:FACULTY DERMATOLOGY, PC
Entity type:Organization
Organization Name:FACULTY DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-988-8918
Mailing Address - Street 1:340 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7503
Mailing Address - Country:US
Mailing Address - Phone:212-988-8918
Mailing Address - Fax:212-744-6108
Practice Address - Street 1:6903 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1509
Practice Address - Country:US
Practice Address - Phone:718-238-6161
Practice Address - Fax:718-238-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113002207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY899752Medicare UPIN