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Organization
DERMEDX DERMATOLOGY PC
Active
Organization
DERMEDX DERMATOLOGY PC
Active
Other names
Dermatique
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY A SOLOMON M.D., J.D. (PRESIDENT)
(631) 265-1351
Entity
Organization
Contact information
Practice address
222 E MAIN ST, SUITE 228, SMITHTOWN, NY 11787-2871
(631) 265-1351
(631) 265-9363
Mailing address
222 E MAIN ST, SUITE 228, SMITHTOWN, NY 11787-2871
(631) 265-1351
(631) 265-9363
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
195658
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01785368
—
NY
01
—
110501
MEDICARE INDIVIDUAL #
NY
01
—
1740242031
NPI
NY
01
—
W17942
MEDICARE GROUP #
NY
Enumeration date
03/27/2007
Last updated
07/08/2011
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