Organization
WAINWRIGHT DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT WAINWRIGHT MD (PRICIPAL PHYSICIAN - ONE MEMBER LLC)
(914) 763-3000
Entity
Organization
Contact information
Practice address
19 NORTH SALEM ROAD, 2ND FLOOR, CROSS RIVER, NY 10518-0365
(914) 763-3000
(718) 518-8616
Mailing address
PO BOX 365, CROSS RIVER, NY 10518-0365
(914) 763-3000
(718) 518-8616
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
234018
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598737462
INDIVIDUAL NPI
—
Enumeration date
07/12/2007
Last updated
01/23/2012
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