Basic Information
| Provider Information | |||||||||
| NPI: | 1639495732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MANHATTAN DERMATOLOGY AND COSMETICS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 2ND AVE RM 3A | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100174534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126613376 | ||||||||
| FaxNumber: | 2126613366 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 2ND AVE | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126613376 | ||||||||
| FaxNumber: | 2126613366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2010 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | AMIN | ||||||||
| AuthorizedOfficialFirstName: | SNEHAL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2126613376 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NP0225X | 222859 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207ND0101X | 222859 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NS0135X | 222859 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207N00000X | 222859 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 1447255427 | 01 | NY | NPI | OTHER | 1720311400 | 01 | NY | NPI | OTHER | 1326129990 | 01 | NY | NPI | OTHER | 1558380816 | 01 | NY | NPI | OTHER | 1376585539 | 01 | NY | NPI # | OTHER |