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Contact Information

ISLAND DERMATOLOGY, PC
604 E PARK AVE
LONG BEACH, NY11561-2505
 Phone: 516-432-0011
 Fax: 516-432-1686
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
 

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for ISLAND DERMATOLOGY, PC

NPI Number 1316996937
LBN Legal business name ISLAND DERMATOLOGY, PC
Authorized official RONALD FALCON - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/09/2006
Last updated 07/05/2011 - About 15 years ago
Identifiers
NY Medicaid 01453341
Other 14478 AETNA,USHEALTHCARE
Other 373723 AMERIHEALTH
Other W23131 BLUE CROSS/BLUE SHIELD
Other 2200149 GHI
Other 7374 VYTRA
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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