# PENROSE DERMATOLOGY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346601333
- **Authorized official:** DR. CAROLIN PENROSE MD (DERMATOLOGIST)
- **Authorized official phone:** (917) 620-4421

## Contact information

- **Practice address:** 1110 SOUTH AVE, SUITE 400, STATEN ISLAND, NY 10314-3403
- **Practice address phone:** (917) 830-1415
- **Practice address fax:** (917) 830-1418
- **Mailing address:** 1110 SOUTH AVE, SUITE 400, STATEN ISLAND, NY 10314-3403
- **Mailing address phone:** (917) 830-1415
- **Mailing address fax:** (917) 830-1418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 245597-1 | NY | Yes |

## Other

- **Enumeration date:** 03/17/2016
- **Last updated:** 06/28/2016