Provider Demographics
NPI:1902805583
Name:JANET H. PRYSTOWSKY MD, PC
Entity Type:Organization
Organization Name:JANET H. PRYSTOWSKY MD, PC
Other - Org Name:DERMATOLOGIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:PRYSTOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-230-1212
Mailing Address - Street 1:110 E 55TH ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4540
Mailing Address - Country:US
Mailing Address - Phone:212-230-1212
Mailing Address - Fax:212-230-1331
Practice Address - Street 1:110 E 55TH ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4540
Practice Address - Country:US
Practice Address - Phone:212-230-1212
Practice Address - Fax:212-230-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171322207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98652Medicare UPIN
NY06E781Medicare ID - Type Unspecified