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Organization

ADVANCED DERMATOLOGY OF NEW YORK PC

Active
Other names
advanced dermatology associates
Organization subpart
No

Provider details

NPI number
Authorized official
LAWRENCE D JAEGER D.O. (OFFICER)
(212) 262-2500
Entity
Organization

Contact information

Practice address
291 E 149TH ST, BRONX, NY 10451-5601
(718) 742-1000
(212) 765-3210
Mailing address
200 CENTRAL PARK S, SUITE 107, NEW YORK, NY 10019-1436
(212) 262-2500
(212) 765-3210

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1508048240
NPI
Enumeration date
12/05/2007
Last updated
12/10/2014
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