Provider Demographics
NPI:1730213943
Name:SUTTON PLACE DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:SUTTON PLACE DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANASTASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-838-0270
Mailing Address - Street 1:445 EAST 58TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-838-0270
Mailing Address - Fax:212-753-5329
Practice Address - Street 1:445 EAST 58TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-838-0270
Practice Address - Fax:212-753-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447255427OtherNPI
NY1487657771OtherNPI
1861499147OtherNPI
NYB14614Medicare UPIN
NYG02854Medicare UPIN
1447255427OtherNPI