Provider Demographics
NPI:1285082073
Name:MIDTOWN DERMATOLOGY SERVICES PC
Entity type:Organization
Organization Name:MIDTOWN DERMATOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GERONEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-686-7306
Mailing Address - Street 1:317 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4974
Mailing Address - Country:US
Mailing Address - Phone:212-686-7306
Mailing Address - Fax:212-686-7305
Practice Address - Street 1:317 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4974
Practice Address - Country:US
Practice Address - Phone:212-686-7306
Practice Address - Fax:212-686-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249579207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty