Provider Demographics
NPI:1699920116
Name:SADICK AESTHETIC SURGERY AND DERMATOLOGY
Entity type:Organization
Organization Name:SADICK AESTHETIC SURGERY AND DERMATOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGLAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-772-7242
Mailing Address - Street 1:911 PARK AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0385
Mailing Address - Country:US
Mailing Address - Phone:212-772-7242
Mailing Address - Fax:212-517-9566
Practice Address - Street 1:911 PARK AVE
Practice Address - Street 2:STE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0385
Practice Address - Country:US
Practice Address - Phone:212-772-7242
Practice Address - Fax:212-517-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134797207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty