Provider Demographics
NPI:1851637821
Name:THE DERMATOLOGY AND PLASTIC SURGERY GROUP, PLLC
Entity type:Organization
Organization Name:THE DERMATOLOGY AND PLASTIC SURGERY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-707-4311
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-884-0444
Mailing Address - Fax:212-419-3891
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-884-0444
Practice Address - Fax:212-419-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233858174400000X
NY245842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100083429Medicare PIN